DECREASED SERUM-CHOLESTEROL LEVEL AFTER SNAKE BITE (VIPERA-PALAESTINAE) AS A MARKER OF SEVERITY OF ENVENOMATION

In 44 patients bitten by snakes [Vipera palaestinae], admission serum cholesterol levels were negatively correlated with severity of envenom ation (mean +/- SD, 175 +/- 49, 137 +/- 36, and 96 +/- 40 mg/dl, respe ctively, in cases with mild, moderate, and severe clinical manifestati ons [p < 0.0001]). Concomitant decreases in serum albumin were not sig nificant. These findings were supported by experimental results in rab bits, in which low, medium, and high doses of purified V. palaestinae venom (all in the nonlethal range), led to dose-dependent decreases in serum cholesterol, at 180 minutes, of 9.5% +/- 8.9%,18.6% +/- 10.1%, and 32.7% +/- 11.8%, respectively (p < 0.01). This rapid decrease in s erum cholesterol level is only partially explained by transcapillary l ipoprotein leakage and probably indicates changes in lipoprotein trans port and metabolism caused by the phospholipase A2 component of V pala estince venom. Admission total serum cholesterol level may serve as on indicator of severity of envenomation in patients bitten by snakes of the Vipera genus before full development of the clinical syndrome.