Therapeutic approach to the patient victim of bothropic accident: a literature review

  • Iara Maria Oliveira de Carvalho UFCG- Cajazeiras
  • Ana Carolina Araújo de Queiroga Lima
  • Ana Lice Mendes Costa
  • Marly Rios Gaspar de Oliveira
  • Rebeca Karollyne Rolim Ribeiro
  • Natália Bitu Pinto
Keywords: Snake Accident, Bothrops, Conduct of drug treatment, Toxicology

Abstract

Introduction: In Brazil, approximately 250 species of snakes are registered, ¼ of these being venomous, bearing glands for the production and secretion of venoms. Also in the national territory, about 90% of snakebites are triggered by snakes known as jararaca, jararacuçu, urutu and caiçara. Thus, since 1988 events associated with the Bothrops genus must be compulsorily notified. Geographically, attacks are more prevalent in the South, Southeast and Midwest. The registered age group is wide, ranging between 15 and 49 years, being more prevalent in males. The toxicodynamics of bothropic venom is evidenced by its coagulant, proteolytic and vasculotoxic action, determining the mild, moderate or severe forms, with local or systemic manifestations. Methodology: This was an integrative literature review carried out in May 2021 with a qualitative and descriptive approach. As guiding topics, the clinical presentation, diagnosis and therapeutic approach to snakebites triggered by Jararaca were considered. For the search, the databases Scielo, PubMed, Lilacs and the PLOS portal were used, in addition to the health science descriptors “poison”, “bothrops” and “snake bites”. According to the inclusion criteria, productions with available full text published between the years 2001 and 2020, in Portuguese and English, were accepted. Duplicate articles and articles with deviations from the theme were excluded. In all, 15 studies were included. Literature survey: The approach to the patient is intrinsically related to the recognition and early management of the clinical picture based on accurate anamnesis and targeted physical examination. Bothrops venom is known to consist of several important classes of toxins. In this sense, the clinical manifestations will depend on the time elapsed after the bite, being perceived in the first 06 hours an acute local inflammatory reaction. If care is delayed, systemic effects may evolve: consumption coagulopathy, potentiation of the hemorrhagic effect, cardiovascular shock, possibility of developing acute renal failure and progressive chronicity due to irreversibly suffered aggressions. Laboratory investigation is relevant for the diagnosis and complementary exams should be requested following the clinical-temporal reasoning. Therefore, the treatment consists of associating general and specific measures, so that the team must be able to assess the severity of the involvement and determine the amount of antiophidic substance to be administered. To neutralize the toxic action, the use of intravenous antibothropic serum is recommended as early as possible. A large part of the accidents occur, however, in rural areas without access to serum therapy, thus demanding the investigation of new associations in the animal, plant and mineral kingdoms so that the conduct against bothropic poisoning is more accessible and disseminated. Conclusion: the involvement of the economically active population, the frequency and high rate of morbidity and mortality signal bothropic accidents as a serious public health problem. Although effective, the delay in administration correlated with poor serum distribution is a strong aggravating factor for the poisoning situation, suggesting urgency and agility. Additionally, there is a need for broader research on the use of plant and synthetic compounds in the most recent therapies.
Published
2022-02-02
How to Cite
Oliveira de Carvalho, I. M., Araújo de Queiroga Lima, A. C., Mendes Costa, A. L., Gaspar de Oliveira, M. R., Rolim Ribeiro, R. K., & Bitu Pinto, N. (2022). Therapeutic approach to the patient victim of bothropic accident: a literature review, 15(1), 5-16. https://doi.org/10.22280/revintervol15ed1.501