AN EXAMINATION OF SERIAL URINALYSES IN PATIENTS WITH NORTH-AMERICAN CROTALID ENVENOMATION

Study Objective: To examine the incidence of abnormal urinalyses after rattlesnake envenomations and its association with bite severity and antivenom administration. Methods: A retrospective review of data coll ected in a prospective manner for an experimental crotalid antivenom t rial. Subjects were individuals with minimal to moderate North America n crotalid envenomations. Incidence and characterization of abnormal u rinalysis after crotalid envenomation is presented. Additionally, the relationship of abnormal urinalysis to bite severity is examined. A pr eliminary test of antivenom protein urinalysis interference was also c onducted. Results: Forty-three percent of the urinalyses reported prio r to antivenom treatment had abnormalities, Thirty-three of 41 subject s (80%) had an abnormal urinalysis, defined as the presence of cells, blood, glucose, or protein, at some time during the 2- week period fol lowing envenomation, All but 3 of these subjects had urinalyses which returned to normal by 2 weeks postenvenomation, Fifteen of 22 subjects (68%) with minimal envenomations had an abnormal urinalysis at some t ime following envenomation, while 18 of 19 subjects (95%) with moderat e envenomations had abnormal urinalyses (p < 0.05), In addition, high concentrations of antivenom added to urine were found to produce a pos itive urine dipstick test for protein. Conclusion: In our study of pat ients with minimal to moderate North American crotalid envenomations, there was a high incidence of abnormal urinalyses. The urine abnormali ties tended to be more common with increased bite severity and more fr equent during the first few hours following envenomation, Antivenom ap pearance in the urine could be responsible for some of our findings.