Snake bites in China: the medical consequences

by Michael Woodhead
Living in Australia, I am naturally extremely wary of snakes, given that this continent has many of the world's most venomous and aggressive varieties - often living in your back yard. Aussies know that if you get bitten by a snake you need to use pressure immobilisation and get help - quick. But what about China? What are the chances of being bitten by a snake and how dangerous are they?
A new report of snake bites from  Hainan gives some idea of what might happen. In a review of more than 1000 cases of snake bites, Dr Shuang Jiebo and colleagues from the 425 PLA Hospital in Sanya, found that the vast majority were caused by pit vipers (46% - aka Trimeresurus stejnegeri) or cobras (40%). Most of the bites occurred in summer (April-Sept) in young males, typically farmers or fishermen, and the bites were mostly on the legs or arms. According to the article the pit viper venom contains a potent haemotoxin, but is not usually fatal:
"The wound usually feels extremely painful, as if it had been branded with a hot iron, and the pain does not subside until about 24 hours after being bitten. Within a few minutes of being bitten, the surrounding flesh dies and turns black, highlighting the puncture wounds. The wound site quickly swells, and the skin and muscle become black due to necrosis."
The Hainan doctors found that most of the wound sites of pit viper bite victims showed swelling, and the skin and muscle became black due to necrosis. In contrast, the cobra venoms are mainly neurotoxic, hemotoxic and cardiotoxic. "The cobra bite is extremely painful and the swelling appears immediately. Other symptoms may include drowsiness, nausea, vomiting, abdominal pain, mental alertness and respiratory failure. "
In their review, about a third of snake bites caused mild envenomation, and only 11% resulted in severe envenomation, which meant a longer hospital stay - often a week or more. Only 1% of patients died, and these tended to be due to bites by sea snakes or King Cobras.
Treatment outcomes were better when patients received prompt treatment - and the researchers also claimed that "Sheyao" traditional medicine was a good remedy for snake bites. This is said to contain  toad skin, centipede, and 'humifuse euphorbia' herb as well as paris polyphylla.
"Prevention, pre-hospital management (first aid) and the importance of the early transfer to the hospital should be emphasized," they concluded. 

Medications the most comon cause of poisoning in Shanghai

by Michael Woodhead
Overdoses of medications such as sedatives and OTC cough remedies are the most common reasons for people needing treating for acute poisoning in Shanghai hospitals, a study has shown.
A review by forensic scientists of 230 cases of acute poisoning treated at Shanghai hospitals found that the most frequent substances leading to acute poisoning were sedative-hypnotic drugs, antipsychotic drugs, antiepileptics, cough suppressants, analgesics, antidiarrheals, and histamine receptor antagonists. Other common reasons for poisoning were ingestion of pesticides, volatile compounds, and natural toxins. Overall, medications accounted for 48% of female poisonings and 40% of male poisonings.
The researchers aid it was interesting that pesticide ingestion accounted for only 17% of all acute poisonings, which was a figure lower than for less developed parts of China. Also of interest was the very low rate of acute alcohol poisoning, which only accounted for two cases (1% of total poisonings). The researchers said this might be because alcohol poisoning was easily recognised and often self treated.
"In conclusion, the pattern of acute poisonings in Shanghai is similar to that of Japan and some European countries in that acute poisonings are mainly due to medications," the study authors wrote.
"Therefore, the relevant government departments should develop more publicity, education, and management strategies for the rational and safe use of medications. In addition, Shanghai should establish more counseling agencies and websites to address the mental problems of the public that have been brought about by rapid economic development."
Source: Journal of Forensic Sciences