[영문]Of the approximately 2,400 species of snake in the world, about 300 are known to be posionous to man. According to the reports of Lee(1967), Paik(1970), Shin et al(1971) and Gloyd(1972), 3 out of the 14 species of Korean snakes are poisonous. These species are Agkistrodon saxatilis, Agkistrodon blomhoffii brevicaudus and Agkistrodon calaginosu. To data, the venoms are known to conta in 10 kinds of enzymatic proteins and 3 kinds of non-enzymatic proteins. The latter are classified according to tissue response as neurotoxin, cytolysin and hematoxin.
The present study includes a summary of 82 consecutive cases of snake poisoning who were treated in Wonju Union Christian Hospital, Wonju, Korea, between January 1960 and July 1973 and, in addition, results of a study of venoms on experimental animals.
Fifty-eight males and twenty-four females, a ratio of 2.4:1, were included in the series of cases. Patients were between 1 and 70 years of age.
Snake bites occurred most frequently in the summer time especially in July and August. Twenty-three patients were bitten on the upper extremities, 56 patients on the lower extremities, 2 patients on the face and one on the abdomen. Tourniquets were applied by the patients in 34 cases. Amputations were later required in 3 of 9 patients who had tourniquet in place for longer than 24 hours. Systemic symptoms were fever, dyspnea, nausea and vomiting, haziness of visual field, disturbance of
consciousness, abdominal pain, ptosis of eyelids, diarrhea, dizziness, hyposthesia, dysarthria, melena and petechia. Local symptoms and signs consists of pain, swelling, discoloration of skin, bleeding from the wound, bullae formation, skin ulceration, subcutaneous necrosis and osteomyelitis. One to eight fang marks were found; 5 cases had over 4 fang marks.
Anemia was found in 23 cases(41%), this may have resulted from hemorrhage, hemolysis and secondary infection of the wound. Bleeding times were within normal range, but coagulation times were prolonged in 4 severe cases. The prothrombin time was prolonged in 26 cases(84%). Serum amylase, SGOT, SGPT and total bilirubin were markedly increased, but total protein and serum albumin were decreased. BUN and blood sugar were increased in 2 critical cases. RBC fragility was increased in 2 cases. Urine protein was detected in 52 cases(51.9%). Skin biopsies showed
hyperkeratosis, bullae formation, telangiectasis, edema and non-specific inflammations.
There were 2 deaths in 82 cases for a mortality of 2.4%. Two cases of autopsy revealed pulmonary edema, hyaline change and hemorrhage in the myocardium.
In animal studies, rats were bitten on the face by Agkistrodon blomhoffii brevicaudus and Agkistrodon calaginosus. Mortality rates were 55.6% and 25.0% respectively. Massive edema and hemorrhage from bites were noted.
Rabbits administrated venom intravenously into the ear vein developed shock and flaccid paralysis within 3 minutes and conjunctival hemorrhage and hematuria in 15 minutes. Hemorrhage in lung, heart, stomach, intestine and ovary were confirmed by
In envenomated rabbits, SGOT, SGPT, alkaline phosphatase, blood sugar, bilirubin and thymol turbidity were increased markedly. Amylase was unchanged. Total protein and albumin were decreased.
These data suggests that poisoning from venomous Korean snake bites may be partially caused by the enzymatic component of the venom acting in concert with the hematoxin, neurotoxin and cytolysin.