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therapy was significantly associated with mor- tality (P=0.002) 4. Therefore, the use of steroids in HUVTH is limited to cases in which laryngeal edema is severe and may prevent tracheostomy.
5. Antivenin- it has been shown that treatment
with low specific antivenin dose (10 mL) did not decrease mortality rate in dogs 4. However, in humans, the mortality is reported to decrease sharply from 6-10% to 0.5-2% since the intro- duction of the specific antivenin 12. Our recom- mendations, based on the findings in human medicine and our clinical experience, are that antivenin is to be administered to effect in cases of:
· Clinical signs of shock.
· Severe swelling at the site of the bite.
· Abnormal coagulation parameters, including throm- bocytopenia.
· Owner’s financial abilities (10 mL cost in Israel ap- proximately $250).
6. Monitoring for 24 h. This includes complete blood count (CBC), creatinine (q12h), PT and aPTT (q12h), PCV/TS (q12h), ECG (q2h), and blood pressure.
In conclusion, as was demonstrated by VP, a member
of the viper family, viper snakebite has relatively low mortality rate both in human and in dogs. Further investigation of snakebites in cats is needed. Risk factors for mortality include the first months of the summer, low patient body weight, limb envenomation, systemic clinical signs and coagulation disorders. Treatment with steroid is controversial and should be further investigated, while antivenin should be considered in cases in which one
of the risk factors to death is present and not as a fixed dose but rather to effect.
References
1. Michael E. Peterson, MS Snake Envenomation International Veterinary Emergency and Critical Care Symposium, May 2007, New Orleans.
2. Kangström, L. E. Snake bites (Vipera berus) in dogs and cats. Sven Veteri 1989;41: 38-46
3. Segev G, Shipov A, Klement E, et al. Vipera palaestinae envenom- ation in 327 dogs: a retrospective cohort study and analysis of risk factors for mortality. Toxicon 2004;43: 691-6994.
4. Lenchner I, Aroch I, Kelmer E, Segev G, Bruchim Y. Vipera palestina envenomation in cats (2006-2012) a retrospective study of 18 cases. J Vet Emerg Crit Care. 2014 in press.
5. Shiloah J, Klibansky C, de Vries A, et al. Phospholipase B activity of a purified phospholipase A from Vipera palestinae venom. J Lipid Res 1973;14: 267-278.
6. Allon, N. and Kochva, E. The quantities of venom injected to pray of different size by Vipera palaestinae in a single bite. J of Expe Zoo 1974;188: 71-76.
7. Leisner S, Aroch I, Perl S, et al. Acute myocardial necrosis associ- ated with Vipera xanthina palestinae bite in a dog. Is J of Vet Med 1999;54: 81-85.
8. Segev, G. Ohad, DG. Shipov, et.al. Cardiac arrhythmias and serum cardiac troponins in Vipera palaestinae envenomation in dogs. J Vet Intern Med. 2008;22(1):106-13.
9. Langhorn R, Persson F, Ablad et al. Myocardial injury in dogs with snake envenomation and its relation to systemic inflammation. JVEC- CS, 2013, San Antonio, ahead of print.
10. Mazaki-Tovi, M. and Lavy, E. (1999) Suspected Vipera palestinae envenomation in three cats. Veterinary and Human Toxicology 41, 145-148
11. Ben Abraham, R., Winkler, E., Eshel, G., Barzilay, Z. and Paret, G. Snakebite poisoning in children-a call for unified clinical guidelines. Eur J of Emer Medi 2001;8: 189-192.
12. Garland, T. (2000) Recognition and treatment for snakebites. In proceedings. 18th Annual American College of Veterinary Internal Medicine Seattle, USA. Pp-48-49
13. Efrati, P. and Reif, L. Viper bites. Fam Phys 1977;7: 94-104 (in Hebrew).
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