Palmira Cupo; Marisa M. Azevedo Marques; Sylvia Evelyn Hering
RESUMO
Foram atendidas no Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto/USP, durante os anos de 1980 a 1989, 21 crianças vítimas de acidente crotálico, 16 das quais apresentaram sinais clínicos de envenenamento grave à admissão e 5, de envenenamento moderado. Quatro pacientes (20%) desenvolveram necrose tubular aguda, dois dos quais necessitaram métodos dialíticos. Um paciente (5%) foi a óbito no 13.° dia do acidente, após intercorrências graves, como hemorragia digestiva e insuficiência respiratória aguda. São apresentadas as características clínicas, laboratoriais e epidemiológicas do acidente crotálico nesses pacientes, enfatizando os conhecimentos atuais sobre a fisiopatologia do envenenamento por Crotalus durissus terrificus. Ao mesmo tempo, pretendeu-se contribuir para a correta abordagem terapêutica, no que diz respeito ao emprego adequado do soro antiveneno e à prevenção da necrose tubular aguda, a mais séria e grave complicação do acidente crotálico.
Palavras-chave: Crotalus durissus terrificus. Acidentes ofidicos em crianças. Rabdomiólíse. Mioglobinúría.
ABSTRACT
At the Hospital of Clinics of the Faculty of Medicine of Ribeirão Preto/USP during the years 1980-1989 21 children have been attended after rattlesnake bite: 16 severe and 5 with moderate envenomation. Four (20%) developed acute tubular necrosis 2 necessitating dialysis. One patient died 13 days after the bite and grave complications including digestive hemorrhage and acute respiratory insuficiency. All patients preserved clinical laboratory and epidemiological characteristics of Crotalus durissus terrificus envenomation. We also comment on the correct management of such patients specially related to antivenin dosage and the prevention ofacute tubular the most serious complication of such an accident.
Keywords: Crotalus durissus terrificus. Snake bites in children. Rhabdomyolysis. Myoglobinuria
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Endereço para correspondência:
Dra. Palmira Cupo.
Depto Pueric. e Pediatria Fac. Med Rib.
PretoiUSP
14049
Ribeirão Preto, SP.
Recebido para publicação em 09/10/90.
Departamentos de Puericultura e Pediatria e Clínica Médica da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP.
