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Type: Artigo de periódico
Title: Compartment Syndrome After Bothrops Jararaca Snakebite: Monitoring, Treatment, And Outcome.
Author: Bucaretchi, Fábio
de Capitani, Eduardo Mello
Hyslop, Stephen
Mello, Sueli Moreira
Madureira, Paulo Roberto
Zanardi, Veronica
Ferreira, Daniel M
Meirelles, Guilerme V
Fernandes, Luciane C R
Abstract: To report the outcome of a patient who developed compartment syndrome after Bothrops jararaca snakebite. A 39-year-old male was admitted 5 h after being bitten on the lower right leg. Physical examination revealed tense swelling, ecchymosis, hypoesthesia, and intense local pain that worsened after passive stretching, limited right foot dorsiflexion, and gingival bleeding. The case was classified as moderate/severe and eight vials of bothropic antivenom (AV) were infused 1 h postadmission. The main laboratory findings upon admission were incoagulable blood (incoagulable PT, aPTT, and INR), thrombocytopenia, serum creatine kinase (CK) of 580 U/L (reference value < 170 U/L), and a serum venom level of 33.7 ng/mL (ELISA; cutoff = 2.3 ng/mL). High anterior compartment pressure (60 mmHg) was identified 8 h post bite, with progressively lower pressures after AV administration and limb elevation (36 mmHg; 19 h post bite). However, moderate pain and limited foot dorsiflexion persisted. In addition, there was a progressive increase in serum CK (6,729 U/L; 45 h post bite), as well as marked edema and hemorrhage of the anterior compartment detected by magnetic resonance imaging (MRI) at 48 h post bite. A fasciotomy done after a further increase in intracompartmental pressure (66 mmHg, 57 h post bite) revealed hemorrhage/necrosis of the anterior tibial muscle that subsequently required partial resection. The patient developed a local infection (day 15 post bite) and a permanent fibular palsy. Compartment syndrome is an unusual but severe complication of snakebites. MRI, in conjunction with subfascial pressure measurements, may be useful in the diagnosis of compartment syndrome after snakebites.
Subject: Animals
Bacterial Infections
Biological Markers
Compartment Syndromes
Crotalid Venoms
Enzyme-linked Immunosorbent Assay
Magnetic Resonance Imaging
Middle Aged
Monitoring, Physiologic
Snake Bites
Treatment Outcome
Citation: Clinical Toxicology (philadelphia, Pa.). v. 48, n. 1, p. 57-60, 2010-Jan.
Rights: fechado
Identifier DOI: 10.3109/15563650903356201
Date Issue: 2010
Appears in Collections:Unicamp - Artigos e Outros Documentos

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