Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus)
Autor(a) principal: | |
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Data de Publicação: | 1991 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Revista do Instituto de Medicina Tropical de São Paulo |
Texto Completo: | https://www.revistas.usp.br/rimtsp/article/view/28831 |
Resumo: | Three patients presented respiratory abnormalities following Crotalus durissus snakebite. These abnormalities appeared in the first 48 h after the snake bite and consisted of dyspnea, tachypnea, use of accessory muscles of respiration (cases 1 and 2) and flaring of the nostrils (case 2). Cases 1 and 2 developed acute respiratory failure. Case 2, 24 h after the snakebite presented difficult breathing and periods of apnea. He was intubated in the emergency room and transferred to the intensive case unit where he arrive with spontaneous breathing. His respiratory pattern worsened and measurement of arterial pH and blood gases showed metabolic and respiratory acidosis with partial carbon dioxide pressure increasing from 40 to 50,3 mmHg compatible with acute ventilatory failure. Both patients needed mechanical ventilation. Weaning from the ventilator was accomplished after 33 days in case 1 and after 15 days in case 2. Both patients also presented acute renal failure treated with peritoneal dialysis with full recovery of the renal function. Measurements of forced vital capacity (FVC) and forced expiratory volume in the first second (FEV 1.0) was carried out 58 hours after the snakebite in case 3. Both FVC and FEV 1.0 were reduced in relation to the predicted values (60 and 67% respectively) but the ratio FEV 1.0/FVC was in the normal range. These findings were compatible with a restrictive pattern of ventilatory failure. Serial measurements showed progressive increase of both FVC and FEV 1.0 reaching 72 and 79% of the predicted values, respectively, in the 10 th day after the snakebite. Case 1 developed deep coma attributed to cerebral hypoxia suffered during several episodes of seizure and died of pulmonary infection 10 months after the snakebite. Cases 2 and 3 recovered completely. These respiratory abnormalities were attributed to the action of crotoxin in the respiratory muscles since the patients did not present complications such as severe uremia, atelectasis, pulmonary infection, cardiac failure and pulmonary edema that could also produce them. |
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Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) Respiratory abnormalities following Crotalus durissus snakebite Insuficiência respiratória agudaAcidente ofídicoCrotalus durissus Three patients presented respiratory abnormalities following Crotalus durissus snakebite. These abnormalities appeared in the first 48 h after the snake bite and consisted of dyspnea, tachypnea, use of accessory muscles of respiration (cases 1 and 2) and flaring of the nostrils (case 2). Cases 1 and 2 developed acute respiratory failure. Case 2, 24 h after the snakebite presented difficult breathing and periods of apnea. He was intubated in the emergency room and transferred to the intensive case unit where he arrive with spontaneous breathing. His respiratory pattern worsened and measurement of arterial pH and blood gases showed metabolic and respiratory acidosis with partial carbon dioxide pressure increasing from 40 to 50,3 mmHg compatible with acute ventilatory failure. Both patients needed mechanical ventilation. Weaning from the ventilator was accomplished after 33 days in case 1 and after 15 days in case 2. Both patients also presented acute renal failure treated with peritoneal dialysis with full recovery of the renal function. Measurements of forced vital capacity (FVC) and forced expiratory volume in the first second (FEV 1.0) was carried out 58 hours after the snakebite in case 3. Both FVC and FEV 1.0 were reduced in relation to the predicted values (60 and 67% respectively) but the ratio FEV 1.0/FVC was in the normal range. These findings were compatible with a restrictive pattern of ventilatory failure. Serial measurements showed progressive increase of both FVC and FEV 1.0 reaching 72 and 79% of the predicted values, respectively, in the 10 th day after the snakebite. Case 1 developed deep coma attributed to cerebral hypoxia suffered during several episodes of seizure and died of pulmonary infection 10 months after the snakebite. Cases 2 and 3 recovered completely. These respiratory abnormalities were attributed to the action of crotoxin in the respiratory muscles since the patients did not present complications such as severe uremia, atelectasis, pulmonary infection, cardiac failure and pulmonary edema that could also produce them. São analisados três pacientes que apresentaram comprometimento da função respiratória após acidente por Crotalus durissus. As manifestações respiratórias surgiram nas primeiras 48 horas após a picada do ofídio e consistiram de dispnéia, taquipnéia, uso da musculatura acessória da respiração (casos 1 e 2) e batimento das aletas nasais (caso 2). Dois pacientes (casos 1 e 2) apresentaram insuficiência respiratória aguda. O diagnóstico desta complicação no caso 1 foi clínico pois o paciente apresentou apnéia. O paciente do caso 2, 24 horas após o acidente ofídico apresentou dificuldade respiratória intensa e períodos de apnéia sendo intubado, permanecendo em respiração espontânea. Houve agravamento dos sinais clínicos de insuficiência respiratória e a determinação de pH e gases do sangue arterial mostrou em relação ao exame inicial elevação da pressão parcial de gás carbônico (40 mmHg para 50,3 mm Hg) caracterizando insuficiência ventilatória aguda. Ambos foram tratados com emprego de ventilação artificial mecânica, tendo o paciente do caso 1 permanecido no ventilador durante 33 dias e o do caso 2 durante 15 dias. Ambos desenvolveram insuficiência renal aguda, necessitaram de diálise peritoneal e recuperaram a função renal. A paciente do caso 3, apesar dos sintomas e sinais de comprometimento respiratório não apresentou alterações do pH e gases arteriais. Espirometria realizada 58 horas após o acidente mostrou capacidade vital forçada (CVF) e volume espirado no primeiro segundo (VEF1) abaixo do previsto (60 e 67% respectivamente). As espirometrias realizadas nos dias subseqüentes evidenciaram melhora progressiva destes parâmetros. No 10º dia após o acidente constatou-se aumento de 20% da CVF e de 17% do VEF1 comparativamente ao exame inicial. A relação entre VEF1 e a CVF manteve-se praticamente inalterada e em valores próximos ao previsto, caracterizando distúrbio ventilatório do tipo restritivo. O comprometimento respiratório nestes pacientes foi atribuído à ação da crotoxina na musculatura respiratória desde que não se encontravam presentes outras condições etiológicas que pudessem ocasioná-lo como uremia avançada, atelectasias, infecção pulmonar, hipopotassemia, congestão e edema pulmonar agudo. Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo1991-08-01info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://www.revistas.usp.br/rimtsp/article/view/28831Revista do Instituto de Medicina Tropical de São Paulo; Vol. 33 No. 4 (1991); 251-255 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 33 Núm. 4 (1991); 251-255 Revista do Instituto de Medicina Tropical de São Paulo; v. 33 n. 4 (1991); 251-255 1678-99460036-4665reponame:Revista do Instituto de Medicina Tropical de São Pauloinstname:Instituto de Medicina Tropical (IMT)instacron:IMTporhttps://www.revistas.usp.br/rimtsp/article/view/28831/30684Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Pauloinfo:eu-repo/semantics/openAccessAmaral, Carlos Faria SantosMagalhães, Renato AlmeidaRezende, Nilton Alves de2012-07-02T01:30:37Zoai:revistas.usp.br:article/28831Revistahttp://www.revistas.usp.br/rimtsp/indexPUBhttps://www.revistas.usp.br/rimtsp/oai||revimtsp@usp.br1678-99460036-4665opendoar:2022-12-13T16:50:35.818548Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT)true |
dc.title.none.fl_str_mv |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) Respiratory abnormalities following Crotalus durissus snakebite |
title |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) |
spellingShingle |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) Amaral, Carlos Faria Santos Insuficiência respiratória aguda Acidente ofídico Crotalus durissus |
title_short |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) |
title_full |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) |
title_fullStr |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) |
title_full_unstemmed |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) |
title_sort |
Comprometimento respiratório secundário a acidente ofídico crotálico (Crotalus durissus) |
author |
Amaral, Carlos Faria Santos |
author_facet |
Amaral, Carlos Faria Santos Magalhães, Renato Almeida Rezende, Nilton Alves de |
author_role |
author |
author2 |
Magalhães, Renato Almeida Rezende, Nilton Alves de |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Amaral, Carlos Faria Santos Magalhães, Renato Almeida Rezende, Nilton Alves de |
dc.subject.por.fl_str_mv |
Insuficiência respiratória aguda Acidente ofídico Crotalus durissus |
topic |
Insuficiência respiratória aguda Acidente ofídico Crotalus durissus |
description |
Three patients presented respiratory abnormalities following Crotalus durissus snakebite. These abnormalities appeared in the first 48 h after the snake bite and consisted of dyspnea, tachypnea, use of accessory muscles of respiration (cases 1 and 2) and flaring of the nostrils (case 2). Cases 1 and 2 developed acute respiratory failure. Case 2, 24 h after the snakebite presented difficult breathing and periods of apnea. He was intubated in the emergency room and transferred to the intensive case unit where he arrive with spontaneous breathing. His respiratory pattern worsened and measurement of arterial pH and blood gases showed metabolic and respiratory acidosis with partial carbon dioxide pressure increasing from 40 to 50,3 mmHg compatible with acute ventilatory failure. Both patients needed mechanical ventilation. Weaning from the ventilator was accomplished after 33 days in case 1 and after 15 days in case 2. Both patients also presented acute renal failure treated with peritoneal dialysis with full recovery of the renal function. Measurements of forced vital capacity (FVC) and forced expiratory volume in the first second (FEV 1.0) was carried out 58 hours after the snakebite in case 3. Both FVC and FEV 1.0 were reduced in relation to the predicted values (60 and 67% respectively) but the ratio FEV 1.0/FVC was in the normal range. These findings were compatible with a restrictive pattern of ventilatory failure. Serial measurements showed progressive increase of both FVC and FEV 1.0 reaching 72 and 79% of the predicted values, respectively, in the 10 th day after the snakebite. Case 1 developed deep coma attributed to cerebral hypoxia suffered during several episodes of seizure and died of pulmonary infection 10 months after the snakebite. Cases 2 and 3 recovered completely. These respiratory abnormalities were attributed to the action of crotoxin in the respiratory muscles since the patients did not present complications such as severe uremia, atelectasis, pulmonary infection, cardiac failure and pulmonary edema that could also produce them. |
publishDate |
1991 |
dc.date.none.fl_str_mv |
1991-08-01 |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.revistas.usp.br/rimtsp/article/view/28831 |
url |
https://www.revistas.usp.br/rimtsp/article/view/28831 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://www.revistas.usp.br/rimtsp/article/view/28831/30684 |
dc.rights.driver.fl_str_mv |
Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Copyright (c) 2018 Revista do Instituto de Medicina Tropical de São Paulo |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo |
publisher.none.fl_str_mv |
Universidade de São Paulo. Instituto de Medicina Tropical de São Paulo |
dc.source.none.fl_str_mv |
Revista do Instituto de Medicina Tropical de São Paulo; Vol. 33 No. 4 (1991); 251-255 Revista do Instituto de Medicina Tropical de São Paulo; Vol. 33 Núm. 4 (1991); 251-255 Revista do Instituto de Medicina Tropical de São Paulo; v. 33 n. 4 (1991); 251-255 1678-9946 0036-4665 reponame:Revista do Instituto de Medicina Tropical de São Paulo instname:Instituto de Medicina Tropical (IMT) instacron:IMT |
instname_str |
Instituto de Medicina Tropical (IMT) |
instacron_str |
IMT |
institution |
IMT |
reponame_str |
Revista do Instituto de Medicina Tropical de São Paulo |
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Revista do Instituto de Medicina Tropical de São Paulo |
repository.name.fl_str_mv |
Revista do Instituto de Medicina Tropical de São Paulo - Instituto de Medicina Tropical (IMT) |
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||revimtsp@usp.br |
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