Clinical Toxicology最新文献

{"title":"Real world delays in antivenom administration: patient, snake or hospital factors (ASP-33).","authors":"Geoffrey K Isbister, Angela L Chiew, Nicholas A Buckley, Jessamine Soderstrom, Simon Ga Brown, Shane Jenkins, Katherine Z Isoardi","doi":"10.1080/15563650.2024.2433125","DOIUrl":"https://doi.org/10.1080/15563650.2024.2433125","url":null,"abstract":"<p><strong>Objective: </strong>Early antivenom administration is essential for effective treatment. We investigated the delays in antivenom administration.</p><p><strong>Methods: </strong>We reviewed snakebites from the Australian Snakebite Project (2006-2021) given antivenom, presenting to hospital within 12 h. We extracted demographics, snake type, time of bite, hospital arrival, blood collection, antivenom treatment and hospital transfer.</p><p><strong>Results: </strong>There were 2,169 patients recruited to Australian Snakebite Project 1,132 patients received antivenom within 12 h of the bite, and 1,019 of these were envenomated: median age 41 years (IQR: 24-57 years); 738 (72%) males. A pressure bandage was applied in 950 (93%), a median of 15 min (IQR: 5-30 min) post-bite. Specific snakes were identified by venom assays in 855 patients (80%), including 328 brown snakes (32%), 173 tiger snakes (17%), 74 rough-scaled snakes (7%), 85 red-bellied black snakes (8%), 49 taipans (5%) and 26 death adders (3%). Seventy-seven patients (7%) received antivenom without envenomation. The median length of hospital stay was 41 h (IQR: 24-67 h). The median time to hospital was 60 min (IQR: 30-105 min), to first blood tests was 90 min (IQR: 59-154 min) and to antivenom was 235 min (IQR: 155-345 min). There was a median delay in blood tests of 20 min (IQR: 10-37 min) and a median delay to antivenom of 147 min (IQR: 84-249 min). Non-specific systemic symptoms occurred in 641 (63%) patients, which occurred a median of 24 min (IQR: 10-60 min) post-bite, which was at a median of 180 min (IQR: 106 to 275 min) prior to antivenom administration. Time to antivenom in the 314 transferred patients was similar to those not transferred. Time to antivenom was significantly shorter for 189 patients given antivenom prior to transfer, median 183 min (IQR: 110-270 min), compared to 130 patients given antivenom after transfer, median 363 min (IQR: 289-513 min; <i>P</i> <0.001).</p><p><strong>Discussion: </strong>Antivenom administration was delayed on average by 2.5 h after hospital presentation, despite three-quarters arriving in hospital within 3 h, the optimal time for antivenom administration. Patients requiring transfer received antivenom in a similar time, but earlier if administered prior to transfer, highlighting the possible benefits of pragmatic clinical decision-making prior to blood tests.</p><p><strong>Conclusion: </strong>We found the leading cause of delays to antivenom administration after patients arrive in hospital was waiting for blood results. Systemic symptoms occurred early in most cases and could be given greater weight in decisions about early antivenom.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-6"},"PeriodicalIF":3.0,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing toxicovigilance of recreational drugs, including new psychoactive substances, by using data from four European poison centres.","authors":"Aza Kader, Maren Hermanns-Clausen, Antoinette van Riel, Katrin Faber, Laura Hondebrink","doi":"10.1080/15563650.2024.2430311","DOIUrl":"https://doi.org/10.1080/15563650.2024.2430311","url":null,"abstract":"<p><strong>Introduction: </strong>Common recreational drugs and new psychoactive substances pose challenges to public health. This study investigated the feasibility of merging cases of recreational drug poisoning reported to European poison centres.</p><p><strong>Methods: </strong>Four European poison centres (Freiburg, Germany; the Netherlands; Sweden and Switzerland) collaborated in a retrospective, observational study. We collected aggregated data on poisonings with 11 common recreational drugs and case-by-case data on poisonings with new psychoactive substances in 2021 by using anonymized data from electronic case reports.</p><p><strong>Results: </strong>In 2021, 2.0% of the poison centre calls involved poisonings with recreational drugs. The poison centres were contacted about 3,705 patients, involving 4,380 drug exposures, of which 3,708 were common recreational drugs, and 672 were new psychoactive substances. Per million inhabitants, the poisoning rate with common recreational drugs varied between 48 (Freiburg) and 145 (Sweden). Poisonings with amfetamine (22%), cocaine (20%), all delta-9-tetra-hydrocannabinol-containing preparations (20%), and 3,4-methylenedioxymetamfetamine (13%) exposures were most frequent. The poisoning rate per million inhabitants with new psychoactive substances varied between two (Switzerland) and 29 (Netherlands). Cathinones (43%), designer benzodiazepines (28%), and phenethylamines (13%) were the most commonly involved new psychoactive substance classes. Symptoms following cathinone poisoning were tachycardia (35%) and hypertension (13%), while following designer benzodiazepines, somnolence was most prominent (38%). The majority of users of new psychoactive substances were male (67%), 55% were between 18 and 30 years, and 8% involved minors (<18 years).</p><p><strong>Discussion: </strong>This study showed the feasibility of merging data on recreational drug poisoning collected by poison centres in four countries. Despite underestimating the overall incidence of drug-related health incidents, poison centre data offers national coverage, unlike other data sources, such as drug-related emergency department visits.</p><p><strong>Conclusion: </strong>This multi-centre, multi-national study reported a substantial annual number of recreational drug poisonings, with a variable proportion of new psychoactive substances. It shows that poison centre data offers detailed insights into exposures to common recreational drugs and new psychoactive substances, user characteristics, and symptoms. It can be used for comprehensive monitoring of drug-related health incidents on a multi-national level.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-9"},"PeriodicalIF":3.0,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142784219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of squamous cell carcinoma at the bite sites several years following suspected cobra (<i>Naja naja</i>) envenomings.","authors":"Subramanian Senthilkumaran, José R Almeida, Jarred Williams, Harry F Williams, Ponniah Thirumalaikolundusubramanian, Sakthivel Vaiyapuri","doi":"10.1080/15563650.2024.2432407","DOIUrl":"https://doi.org/10.1080/15563650.2024.2432407","url":null,"abstract":"<p><strong>Introduction: </strong>Snakebite envenoming is a multidimensional issue that causes severe functional and life-challenging consequences among rural communities in tropical countries. Current research and treatments are largely focused on the acute effects of envenomation and short-term health outcomes. The knowledge of snakebite-induced long-term consequences is highly limited.</p><p><strong>Case series: </strong>We report the development of squamous cell carcinoma at the bite site several years later in four patients who are suspected to have been bitten by cobras (<i>Naja naja</i>). Following bites, the victims presented typical symptoms of cobra envenomings including ptosis, altered sensorium, and breathing difficulties. However, difficult-to-heal wounds were a chronic health sequelae with frequent desquamation cycles which led to squamous cell carcinoma. Surgery as the primary therapeutic approach was used for all patients to address this issue.</p><p><strong>Discussion: </strong>These patients highlight the importance of squamous cell carcinoma in previously damaged tissue from snakebites as a possible long-term consequence. This emphasises the need for surveillance systems focused on a broad range of snakebite-induced consequences including long-term pathological, psychological, and socioeconomic conditions.</p><p><strong>Conclusion: </strong>This case series describes pathological complications following cobra bites that require further research to determine mechanistic and epidemiological insights in the most affected regions by snakebites, specifically in India.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766920","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comment on \"Elevated osmol gaps in patients with alcoholic ketoacidosis\".","authors":"Knut Erik Hovda, Dag Jacobsen","doi":"10.1080/15563650.2024.2433122","DOIUrl":"https://doi.org/10.1080/15563650.2024.2433122","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From coma to recovery: removal of amanitin by percutaneous transhepatic bile drainage in severe <i>Amanita subjunquillea</i> mushroom poisoning.","authors":"Xiuying Ma, Jiawei Geng, Junfeng Wang, Liping Huang, Jinbo Luo, Chibin Li, Ling Zhu","doi":"10.1080/15563650.2024.2430312","DOIUrl":"10.1080/15563650.2024.2430312","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-2"},"PeriodicalIF":3.0,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142766921","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"2023 Annual Report of the National Poison Data System® (NPDS) from America's Poison Centers®: 41st Annual Report.","authors":"David D Gummin, James B Mowry, Michael C Beuhler, Daniel A Spyker, Laura J Rivers, Ryan Feldman, Kaitlyn Brown, Nathaniel P T Pham, Alvin C Bronstein, Carol DesLauriers","doi":"10.1080/15563650.2024.2412423","DOIUrl":"10.1080/15563650.2024.2412423","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Introduction: &lt;/strong&gt;This is the 41&lt;sup&gt;st&lt;/sup&gt; Annual Report of America's Poison Centers® National Poison Data System®. As of 1 January, 2023, all 55 of the nation's poison centers uploaded case data automatically to NPDS.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;We analyzed the case data, tabulating specific indices from the NPDS®. The methodology was as in previous years. Where changes were introduced, the differences are identified. Cases with medical outcomes of death were evaluated by a team of medical and clinical toxicologists using an ordinal scale of 1-6 to assess the Relative Contribution to Fatality of the exposure.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;In 2023, 2,421,251 closed encounters were logged by the National Poison Data System®: 2,080,659 human exposures, 41,857 animal exposures, 293,663 information requests, 5,046 human confirmed nonexposures, and 26 animal confirmed nonexposures. The upload interval was 4.88 [4.43, 9.33] (median [25%, 75%]) minutes, creating a near real-time national exposure and information database and surveillance system. Total encounters showed a 2.49% decrease from 2022 while human exposure cases increased by 0.764% and health care facility human exposure cases increased by 2.38%. All information requests decreased by 19.1%, medication identification (Drug ID) requests decreased by 14.0%, and medical information requests showed a 61.3% decrease, returning to pre-COVID-19 pandemic numbers. Drug Information requests showed a 17.6% decrease, due to continued declining COVID-19 vaccine calls to poison centers, but these still comprised 21.7% of all information contacts. Human exposures with less serious outcomes have decreased by 1.58% per year since 2008, while those with more serious outcomes (moderate, major or death) have increased by 4.25% per year since 2000.Consistent with the previous year, the top 4 substance classes most frequently involved in all human exposures were analgesics (11.00%), household cleaning substances (7.12%), antidepressants (5.58%), and cosmetics/personal care products (5.01%). Cardiovascular drugs (4.97%) replaced antihistamines as the 5&lt;sup&gt;th&lt;/sup&gt; most common substance class. As a class, analgesic exposures increased most rapidly, by 1,260 cases/year (2.72%/year) over the past 10 years for cases with more serious outcomes.The top 5 most common exposures in children aged 5 years or less were household cleaning substances (10.1%), analgesics (9.13%), cosmetics/personal care products (9.10%), foreign bodies/toys/miscellaneous (8.03%), and dietary supplements/herbals/homeopathic (6.88%). The National Poison Data System® documented 3,272 human exposures resulting in death; 2,700 (82.5%) of these were judged as related (Relative Contribution to Fatality of 1-Undoubtedly responsible, 2-Probably responsible, or 3-Contributory).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;These data support the continued value of poison center expertise and the need for specialized medical toxicology informa","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"793-1027"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142834340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"National Poison Data System^® Annual Report: under the hood.","authors":"James B Mowry","doi":"10.1080/15563650.2024.2429442","DOIUrl":"https://doi.org/10.1080/15563650.2024.2429442","url":null,"abstract":"<p><strong>Introduction: </strong>The 41st National Poison Data System^® Annual Report from America's Poison Centers^® is published in this issue of <i>Clinical Toxicology.</i> This Commentary focuses on comparing the different poisoning-related surveillance systems in the United States while highlighting some of the strengths and weaknesses of the National Poison Data System^®. It also reviews the process underlying the fatality review section of the Annual Report.</p><p><strong>Comparison of poisoning surveillance systems: </strong>In order to place the data reported by the National Poison Data System^® in context, the National Poison Data System^® was compared to other available poisoning surveillance systems in the United States: the American College of Medical Toxicology's Toxicology Investigators Consortium (ToxIC) Registry, the Centers for Disease Control and Prevention Injury Prevention and Control Web-based Injury Statistics Query and Reporting System (WISQARS^™) which partners with the Consumer Products Safety Commission's National Electronic Injury Surveillance System - All Injury Program (NEISS-AIP), and the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) database. Differences exist in the scope and focus of these databases, including the underlying population base and sources of reporting, use of statistical sampling, type of medical outcomes reported, type and number of products/substances reportable, granularity of product/substances reported, case volumes, timeliness of reporting and surveillance activities.</p><p><strong>National poison data system fatality review process: </strong>The National Poison Data System^® mortality data may vary from data collected by other sources but has some characteristics that render it unique, including the publication of narratives of selected fatalities. Each direct death undergoes a rigorous review by medical and clinical toxicologists at the regional poison center and by America's Poison Centers^® Fatality Review Committee. This review process is outlined in detail and compared to other poisoning mortality reporting systems.</p><p><strong>Conclusion: </strong>National Poison Data System^® data from poison centers in the United States provide a unique perspective of the epidemiology of poisoning that is distinct but complementary to other poisoning surveillance systems in the United States. The National Poison Data System^® conducts a rigorous fatality review process that incorporates a variety of inputs that provide additional verification of the poisoning fatalities reported to it. The availability of and routine publication of fatality narratives is a unique feature of the National Poison Data System^®.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":"62 12","pages":"787-792"},"PeriodicalIF":3.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142881406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ethyl chloride poisoning from inhalational misuse: clinical features and outcomes.","authors":"You-Jiang Tan, Shimona Q X Khoo, Youhong Tan","doi":"10.1080/15563650.2024.2424460","DOIUrl":"https://doi.org/10.1080/15563650.2024.2424460","url":null,"abstract":"<p><strong>Introduction: </strong>Ethyl chloride misuse remains a prevailing concern due to its accessibility, but detailed descriptions of the features of toxicity are limited to sporadic reports, resulting in knowledge gaps in their clinical features and diagnosis.</p><p><strong>Objective: </strong>To describe the clinical features, treatment, and outcomes of patients reported in the literature who developed toxicity from inhalational use of ethyl chloride.</p><p><strong>Methods: </strong>We reviewed relevant literature over the past 50 years and analyzed the characteristics and outcomes of patients with toxicity from the inhalational use of ethyl chloride.</p><p><strong>Results: </strong>A total of 21 studies from 1979 to 2024 were identified, making available 22 patients for analysis. Their median age was 40 years (range 16-62 years), and there were more than four times as many males as females. Ethyl chloride-containing cleaning solvents (8/22, 36%) were most commonly used. Regular inhalation of ethyl chloride was documented in approximately two-thirds of the patients (14/22, 66%), with a median duration of five months of misuse (range 2-360 months). A large proportion of patients (15/22, 68%) inhaled ethyl chloride again within a week from the onset of toxicity. Although features of cerebellar dysfunction were very common at presentation (13/16, 81%), abnormalities on neuroimaging studies were rare. Death occurred in more than a quarter of cases (6/22, 27%), with patients either already deceased or dying shortly after. Half (3/6) of these deaths were directly attributable to the development of lethal cardiac dysrhythmias. Conversely, most survivors either improved or fully recovered within a few days to weeks (14/16, 88%), independent of their presenting symptoms, clinical signs, and the treatments they received.</p><p><strong>Discussion: </strong>Ethyl chloride users are likely young or middle-aged males, and clinical features of toxicity can range from transient neurological symptoms to cardiac dysrhythmias and death. The prominence of neurotoxicity may be attributed to the lipophilic nature of ethyl chloride and its tendency to accumulate in neural tissue, while cardiac dysrhythmias have been attributed to cardiac sensitization to catecholamines through ethyl chloride-induced inhibition of potassium, calcium, and sodium channels.</p><p><strong>Conclusions: </strong>Toxicity from the inhalational misuse of ethyl chloride should be considered in young or middle-aged males presenting with acute cerebellar dysfunction. We recommend that suspected cases undergo telemetric monitoring for 24 h, especially when tachycardia and/or palpitations are present, as deaths from lethal cardiac dysrhythmias are not uncommon.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A recent increasing occurrence of etomidate and propoxate/isopropoxate misuse.","authors":"Yee-Ting Cheung, Chun-Wing Yeung, Kelvin Yat-Chung Yu, Choi-Yee Lau, Hok-Fung Tong, Yeow-Kuan Chong","doi":"10.1080/15563650.2024.2423834","DOIUrl":"https://doi.org/10.1080/15563650.2024.2423834","url":null,"abstract":"","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-3"},"PeriodicalIF":3.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"After the bite: evaluating a specialized clinic for follow-up care for snake envenomation.","authors":"William Rushton, Erin Ryan, Jessica Rivera, Matthew Kelly, Sukhshant Atti, Stacy Marshall, Dag Shapshak","doi":"10.1080/15563650.2024.2425068","DOIUrl":"https://doi.org/10.1080/15563650.2024.2425068","url":null,"abstract":"<p><strong>Introduction: </strong>Pit viper envenomation causes tissue damage that can persist for weeks to months despite antivenom. Many patients do not receive post-discharge care beyond testing for late coagulopathy and primary care follow-up. The aim of this report is to describe a snake envenomation patient cohort, complications, and management strategies after three years of operation of a specialized outpatient clinic offering post-discharge evaluation and wound care therapy.</p><p><strong>Methods: </strong>This was an observational study of patients treated in a newly established snakebite follow-up clinic from June 1, 2021 to November 30, 2023. Patient demographics, snake species, and hospital course were abstracted from poison center records. Persistent symptoms upon clinic evaluation were recorded as well as the therapies prescribed by the clinic wound care physicians.</p><p><strong>Results: </strong>Of the 465 snake envenomations reported to the state poison center, 52 patients presented to the clinic. The median patient age was 29 years (range 5-88 years), and the majority (65.4%) were male. Antivenom was given during hospitalization in 92.3% of cases. <i>Agkistrodon</i> spp. envenomations (including <i>Agkistrodon contortrix</i> and <i>Agkistrodon piscivorus)</i> were most common (<i>n</i> = 33) with a smaller number of <i>Crotalus horridus</i> (<i>n</i> = 7) and 12 unidentified pit viper envenomations. Persistent edema (61.5%) and bullae (38.5%) were common at follow-up. Interventions provided included compression (38.5%), physical therapy referral (32.7%), tissue debridement (9.6%), and antibiotics (5.8%). Rates of edema and bullae were numerically higher in patients envenomated by <i>Agkistrodon</i> spp. compared to those envenomated by <i>Crotalus horridus.</i></p><p><strong>Discussion: </strong>In this primarily <i>Agkistrodon</i> spp.-envenomated cohort, persistent edema, wounds, and functional limitations were common in the post-discharge period. Our outpatient snake envenomation clinic leveraged the expertise of wound care physicians and the public health reach of the state poison center to address the significant morbidity seen on follow-up and provide interventions to facilitate recovery.</p><p><strong>Conclusion: </strong>This snake envenomation wound care clinic addressed a neglected aspect of pit viper envenomation by providing post-discharge management of enduring tissue damage and other complications.</p>","PeriodicalId":10430,"journal":{"name":"Clinical Toxicology","volume":" ","pages":"1-7"},"PeriodicalIF":3.0,"publicationDate":"2024-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142726594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}