重篤な症状を呈したが救命できた重症マムシ咬傷

・腎不全，呼吸不全を呈したが救命できた重症マムシ咬傷を経験した．

・マムシ抗毒素血清の投与が遅滞した．

・クレアチンキナーゼは15万 IU／l，白血球は2万／μlを超えた．

・ヘパリン投与で血栓形成を抑制することにより腸管壊死の予防を試みた．

（「症例のポイント」より）

　

A patient rescued from severe mamushi bite that induced severe clinical symptoms

　

Okamoto, Osamu1）Hayashi, Tomokazu2）Nakashima, Ryuta2）Hashimoto, Hiroyuki3）Inagaki, Nobuhiro2） 1）Division of Dermatology, Oita City Medical Association’s Almeida Memorial Hospital 2）Division of Critical Care and Emergency Medicine, Oita City Medical Association’s Almeida Memorial Hospital 3）Division of Plastic Surgery, Oita City Medical Association’s Almeida Memorial Hospital

　

We herein report a case of severe mamushi bite that induced severe clinical symptoms. After being bitten, the patient was admitted to another hospital but not given anti-mamushi venom serum. After renal failure appeared the next day, the patient was transferred to our hospital, and the antiserum was given （25 h after the bite）. However, the levels of creatine kinase and several hepatic transaminases were severely elevated, and respiratory failure appeared. The patient received hemodialysis, respiratory assist, and heparin administration to prevent intestinal necrosis due to thrombosis. Although the renal failure continued for 20 days, the renal function ultimately recovered, and the patient survived and left the hospital.