VIPERA PALAESTINAE SNAKE ENVENOMATIONS - EXPERIENCE IN CHILDREN

In Israel, Vipera palaestinae (V. palaestinae) is the most common veno mous snake, accounting for 100-300 reported cases of envenomation ever y year. However, V. palaestinae snakebites in children have not been e xtensively investigated. The demographic features, treatment and outco me of V. palaestinae envenomation in 37 children treated in two medica l centers over a 9 year period were retrospectively reviewed. The vict ims age ranged from 2-18 years with a mean age of 8.9 years. Twenty-ni ne children were males and eight were females. Twenty-one patients res ided in rural areas, and 16 children were living in urban areas. Twent y-three (63%) of the patients were bitten on the lower limb; Twelve (3 3%) on the upper limb, and two on the head or neck (4%). Using a gradi ng scale of one to three from minimal to severe envenomation, 15 (40.5 %), 15 (40.5%) and 7 (19%) patients had mild, moderate and severe enve nomation, respectively. Major complications of envenomation that were manifested after arrival consisted of compartment syndrome (two patien ts) and respiratory dysfunction (two patients). Specific monovalent an tiserum for the treatment of V. palaestinae bite was given to 16 child ren (43%) of whom, four patients were in the severe group, seven and f ive in the moderate and mild groups respectively. No patient suffered a significant infection, tissue loss, permanent disability or death. W e conclude that early ICU admission along with close monitoring and an tivenom therapy is important in reducing morbidity and mortality in ch ildren systemically envenomed by V. palaestinae.