Biology Reference
In-Depth Information
gingival bleeding. He described a serious clinical course that spanned 5 days. Within
67 h postbite, he reported experiencing headache, “strong maxillary hemorrhage,”
“right radial arm bone pain,” and drowsiness (de Lema, 2007). Over the next few
days he reported fatigue, “strong gingivorrhage,” hematuria, bone pain in upper
and lower limbs, “anuria,” and “left kidney failure” (de Lema, 2007). He precisely
detailed his diet and stool character. It is noteworthy that during a period of pre-
sumed AKI that would have been expected to be associated with uremia, he reported
that his appetite remained unabated and commented on his enjoyment of his meals.
The author indicated that a “well-known toxicologist” was consulted and rec-
ommended left nephrectomy with “graft of an artificial kidney” (de Lema, 2007).
However, shortly thereafter, the author added that tests indicated normal kidney func-
tion and that “surgery was not necessary
…
but it was missing a stimulant factor of the
kidneys because they were almost inert
…
it was not noticed jaundice nor anemia
…
”
(de Lema, 2007). Earlier in the account, without including specific laboratory values,
the author reported coagulopathy and anemia. Treatment reportedly consisted of mul-
tiple blood transfusions, vitamin K, and five ampoules of “global anti-ophidic serum”
(de Lema, 2007). The author also took large quantities of a homeopathic botanical
mixture containing three plant species. The reported symptoms/signs fully resolved
approximately 7-10 days following the incident (de Lema, 2007).
Conclusions and Recommendations
This case account, based on the author/victim's case notes, contains a mixture of
conflicting terminology, misinformation (e.g., “graft of an artificial kidney”), incor-
rect interpretations, speculation, and inappropriate personal details. As the author
is a well-regarded herpetologist, the identification of the snake was probably accu-
rate. Also, although the author's genuine desire to precisely describe his experience
is unquestioned, there is no clear linkage between the described clinical course and
the bite. Included also are incorrect diagnoses, management that is unsupported by
information regarding the disease described in the report, and use of nonallopathic
therapeutics of unproven efficacy.
Basic requirements of any clinical case report include clarity, accuracy, inclusion
of information directly relevant to the case, well-reasoned consideration of a differ-
ential diagnosis, and practical clinical acumen. While it is recognized that English
was not the author's first language, and that this and/or poor translation may have
contributed to a lack of clarity, this report exhibits multiple flaws. Informed analysis
of any snakebite case study must be followed by equally measured and accurate writ-
ten communication of relevant, important features of the case. As the case reported
by de Lema (2007) lacks these essential components, this report cannot be used to
assess the medical importance of
P. trilineatus
.
4.5.2 Perceived Versus Evidence-Based Risk: Human Response to Trauma
and Somatosensory Amplification
Human response to any medical effect from
any
bite inflicted by a snake may lead
to disproportionate concerns. In this, the individual physiological response to minor
