Epidemiological Study and Physiological Analysis of Snakebite Envenoming in China Northern Guangxi Zhuang Autonomous Region-a Retrospective Study

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However, no systematic report of snake injuries in China Northern Guangxi Zhuang Autonomous Region until now. In this study, the details of patients with snake bites were retrospectively retrieved and reviewed. Details regarding age, gender, site of snake bites, consciousness, outcome and clinical features at the time of presentation to the hospital. Methods Data were extracted from the emergency department (2019-2021), epidemiological study and physiological analysis were performed. Results Our data showed that the majority of the bites were from Deinagkistrodon acutus(Da) and Protobothrops mucrosquamatus(Pm) , respectively, accounting for 42.37% and 33.33%. 40.11% of snakebites occur in fields, 37.85% in areas neighboring houses, and 14.69% in mountains. Most bite victims were between 50 -70 years old (52.54%). The mean age was 57.32±15.12 years. There were 120 (67.80%) male victims, while 57 (32.20%) were females. For 93.22% of the patients, the site of bite was in the lower limbs, 6.21% in upper limbs and in 0.56% cases, it was in the head region. In terms of blood coagulation function, 69.33% ( Da ) and 91.53% ( Pm ) patients had normal Prothrombin Time (PT). A significant number of patients (30.66%) with Da bites had increased Prothrombin Time, while Pm only caused 8.47% of the individuals to have such an effect. The influence of Da and Pm bites on White Blood Cells (WBC) count showed an upward trend, with percentages of 41.33% and 61.02%, respectively. A similar trend was observed for neutrophils (48%/61.02%). The venom of both the species had similar effects on K + , Na + , Ca 2+ and Mg 2+ (Normal rate ( Da / Pm ): 72%/71.19%, 100%/96.61%, 84%/83.05%, 68%/66.10%) in vivo . CreatineKinase-MB (CK-M b), Aspartate aminotransferase (AST) level in patients with snake injuries were the most abnormal (Normal rate ( Da / Pm ): 73.33%/62.71%), while the impact on Alanine aminotransferase (ALT), Lactate dehydrogenase (LDH), and albumin was relatively smaller (Normal rate ( Da / Pm ): 86.67%/91.53%, 90.67%/83.05%, 90.67%/83.05%). Conclusions The majority of the snakebites in China Northern Guangxi Zhuang Autonomous Region were from Deinagkistrodon acutus ( Da ) and Protobothrops mucrosquamatus ( Pm ), mostly occurs in fields/neighboring houses/ mountains. Most bite victims were between 50-70 years old. Da and Pm bites showed marked physiological variation, the treatment and monitoring after snakebites should be comprehensive and personalized. Snakebite Epidemiology Retrospective study Introduction Snakebite is a worldwide public health problem, posing an enormous threat to human life in many countries[ 1 – 3 ], and causing huge social costs[ 4 ]. Every year, 1.8 to 2.5 million venomous snakebites occur worldwide, causing at least 1,00,000 deaths[ 5 ]. Lack of precise first aid knowledge and access to quality care lead to severe fatality in human beings following a snakebite[ 6 , 7 ]. The clinical outcome of patients bitten by venomous snakes depends on the type of venomous snake, the depth of the wound, the amount of venom injected, the patient's age, sex, and general health status. Snakebite may also cause a range of clinical sequelae, including thrombosis and neuromuscular paralysis[ 8 ]. The venom secreted by the venom gland of a venomous snake has a variety of active ingredients: polypeptides, and enzymes, making them clinically challenging and scientifically fascinating[ 9 , 10 ]. After a snakebite, these toxic substances quickly enter the human body through the lymphatic system and bloodstream to cause poisoning, which damages multiple organs. Snake venom Phospholipase-A2 causes intravascular hemolysis, producing a large amount of hemoglobin that blocks renal tubules[ 11 ]. It is also associated with the proliferation and de-differentiation of renal tubular epithelial cells[ 12 ]. Snake venom can directly damage the epithelial cells of renal tubules, accelerating the damage to the kidney[ 13 ]. The snake venom contains active proteolytic enzymes that coagulate fibrinogen and damage the blood vessel wall, causing serious bleeding and tissue destruction[ 14 ]. Clinically, neutrophil gelatinase-associated lipocalin (NGAL) showed diagnostic value for renal replacement therapy after snakebite-induced acute kidney injuries[ 15 ]. Interestingly, numerous studies reported that snake venom also has protective effects on acute and chronic nephropathy, in addition, snake venom can also cause hemorrhage, muscular and genetic damage[ 16 – 20 ]. According to the data from the China Association for Disaster & Emergency Rescue Medicine, 47 species of venomous snakes are distributed in China. In Guangdong Province (near Guangxi Zhuang Autonomous Region), the green pit viper , Bungarus multicinctus , Naja atra , and DeinDeinagkistrodon acutus were considered to be the most medically important[ 21 ]. In Chongqing, China, the main venomous snake specie is Trimeresurus mucrosquamatus [ 22 ]. In addition, there are more than 20 snake species are venomous in Taiwan (subtropical region), including Bungarus multicinctus and Naja atra [ 23 ]. However, no systematic report of snake injuries in China Northern Guangxi Zhuang Autonomous Region until now. Northern Guangxi is densely covered with well-developed traditional agricultural land, ditches, and rivers, serving as a snake reserve. Venomous snakebites are a global challenge as they cause clinical dysfunction that ranges from local to systemic levels. Therefore a systematic report of snake injuries in this area is necessary. Accordingly, we have summarized and analyzed the epidemiology, physiological and biochemical functions of snakebite patients (177 were hospitalized in our emergency department from April 2019 to December 2021) from the Second Affiliated Hospital of Guilin Medical University in northern Guangxi. This study aims to provide a reference for the specific diagnosis and treatment of snakebites in this area. Materials and Methods Data collection 177 patients with snakebites were hospitalized in emergency department from April 2019 to December 2021, aged 13–99 years. These patients were divided into ten age groups. The changes in blood coagulation function, blood routine test, electrolyte, liver, heart, and kidney functions were summarized and analyzed according to snake species. No victim death recorded, no victim survived with disability. No victims used Chinese traditional/herbal medicine before hospital presentation. 81.92% victims received antivenom administration, and most were treated within six hours after bites. laboratory tests were carried out 24 hours after the snakebite Diagnostic basis (1) Snake species identification: Identification of snake species was either by the snake capture and subsequent confirmation in the hospital based on its characteristic features such as shape, or by snake species brought to the hospital. Snake identification involved herpetologists and senior clinical doctors in this area. (2) Wound condition: Generally, several tooth marks can be seen, having a shape of "..", with a spacing of 0.5–1.5 cm. The symptoms include local swelling, pain, ecchymosis, bleeding around the wound, and swollen and tender lymph nodes. (3) Clinical condition at the time of hospitalization: At the time of hospitalization, victims with clear consciousness, vital snake bites signs, swelling, wound pain at the site of bite. The hospital examination showed that the white blood cells (WBC) increased and the proportion of neutrophils increased, often accompanied by a decrease in prothrombin time (PT), activated Partial thromboplastin time (APTT), fibrinogen (FIB), platelet (PLT), electrolyte, urine protein, liver function abnormalities, etc. Data analysis Data were extracted from medical records of patients (Department of Emergency Medicine, The Second Affiliated Hospital of Guilin Medical University). Data collectors trained (had access to the snakes/images) on snake identification and further analyzed using PSPP software (Free Software Foundation, Inc.). The clinical characteristics of the 177 patients with snakebites was presented using descriptive statistics. Categorical variables were described by counts and percentage. Results Snake species/Location of snakebites and demographic details To master the species proportion of the snakebites in northern Guangxi, China, we analyzed the snake species bite marks in 177 snakebite patients. The results showed that the major bites were from Deinagkistrodon acutus and Protobothrops mucrosquamatus , respectively, accounting for 42.37% and 33.33% of the total injury rate (Table 1 ). Therefore, in northern Guangxi, the prevention and treatment of snake injuries should focus on Deinagkistrodon acutus and Protobothrops mucrosquamatus bites. Most snakes thrive in ditches, rivers, grassland, and other places. Therefore, venomous snakebites often occur during fieldwork or field operations. According to our data, 40.11% of snakebites occur in fields, 37.85% in areas neighboring houses, and 14.69% in mountains. In addition, there are also some injury rates in factory buildings, riverside, residential areas, and campus, which are 2.82%, 2.82%, 1.13%, and 0.56%, respectively (Table 1 ). The majority of bite victims were 51–60 years of age (29.38%), 61–70 years of age (23.16%). The mean age was 57.32 ± 15.12 years (range 13–99 years). There were 120 (67.80%) male victims, while 57 (32.20%) were females. For 93.22% of the patients, the site of bite was in the lower limbs, 6.21% in upper limbs and in 0.56% cases, it was in the head region. All the patients were conscious (100%) at the time of presentation to emergency room. (Table 2 ). Table 1 Species/Location of snakebites Species/Location % n Deinagkistrodon acutus 42.37% 75 Protobothrops mucrosquamatus 33.33% 59 Species Naja atra 16.38% 29 Bungarus multicinctus 3.95% 7 Trimeresurus stejnegeri 3.95% 7 Fields 40.11% 71 House/neighbouring area 37.85% 67 Mountains 14.69% 26 Location Factory buildings 2.82% 5 Riverside 2.82% 5 Residential areas 1.13% 2 Campus 0.56% 1 Table 2 Distribution of victims Age/Gender etc. Victims Age/Gender distribution, etc. % n(male/female) Age 0–10 0 0(0/0) 11–20 1.69% 3(1/2) 21–30 31–40 41–50 51–60 61–70 71–80 81–90 91–100 5.65% 12.99% 15.25% 29.38% 23.16% 9.04% 2.26% 0.56% 10(7/3) 23(20/6) 27(22/5) 52(30/22) 41(28/13) 16(13/3) 4(2/2) 1(0/1) Gender Male Female 67.80% 32.20% 120 57 Injury site Head 0.56% 1 Upper limb 6.21% 11 Lower limb 93.22% 165 Consciousness Conscious 100% 177 Altered sensorium 0 0 Outcome Alive 100% 177 Dead 0 0 Left against medical advice 0 0 Comparison of blood coagulation function between patients injured by Deinagkistrodon acutus and Protobothrops mucrosquamatus Our research concluded that the two species of snakes that cause the most injuries in northern Guangxi are Deinagkistrodon acutus ( Da ) and Protobothrops mucrosquamatus (Pm) . To further clarify the similarities and differences of the effects of these two kinds of snakes on physiological and biochemical indicators of the body, we compared and analyzed the changes in coagulation function, blood routine, electrolytes, liver, heart, and kidney functions of 75 patients with Da and 59 patients with Pm bites . In terms of blood coagulation function, 69.33% ( Da ) and 91.53% ( Pm ) patients had normal PT(Prothrombin Time). A significant number of patients (30.66%) with Da bites had increased prothrombin time, while Pm only caused 8.47% of the individuals to have such an effect. The Activated Partial Thromboplatin Time (APTT) values of 64% ( Da ) and 96.61% ( Pm ) patients were normal. While 30.66% of Da bite victims had APTT prolongation to varying degrees, only 3.39% of patients with Pm bites had such a variance; The fibrinogen levels in 44% of the Da bite victims and 77.97% of the Pm injured individuals was normal. However, a decline in this indicator was more pronounced in patients with Da bite (49.33%) in comparison to Pm bite victims (13.56%). In addition, 17 snakebites ( Da ) possessed more than 2 fold increasement for PT, 11 snakebites( Da ) possessed less than 0.5 fold decreasement for fibrinogen. (Table 3 ). Thus our data on blood coagulation function shows that the effect of Da snakebite on individuals leads to prolongation of PT and APTT, and a decrease in fibrinogen level, while for the individuals with Pm snakebite, this effect is significantly weakened. Table 3 Comparison analysis of prothrombin time after Da and Pm bites Coagulation function %( Da / Pm ) n ↓ 0/0 0/0 PT Normal(10-16s) 69.33%/91.53% 52/54 ↑ 30.66%/8.47% 23(≥ 2:17)/5(≥ 2:2) ↓ 5.33%/0 4(≤ 0.5:4)/0 APTT Normal(34-40s) 64%/96.61% 48 /57 ↑ 30.66%/3.39% 23/2 ↓ 49.33%/13.56% 37(≤ 0.5:11)/8 Fibrinogen Normal(2-4g/L) 44%/77.97% 33/46 ↑ 6.67%/8.47% 5/5 ↓ decreased; ↑ increased. ≥2:fold change ≥ 2; ≤0.5: fold change ≤ 0.5. Comparison of routine blood examination between patients bitten by Deinagkistrodon acutus vs. Protobothrops mucrosquamatus In terms of routine blood test, the influence of Da and Pm bites on WBC count showed an upward trend, with percentages of 41.33% and 61.02%, respectively. A similar trend was observed for neutrophils(48%/61.02%), as shown in Table 4 . The PLT count was normal in 82.67% ( Da ) and 96.61% ( Pm ) of the patients, while others showed up- or down-regulation in different proportions. The Hb content was normal in 57.33% ( Da ) and 74.58% ( Pm ) of the individuals, while others showed varying degrees of decline or increase (Table 4 ). Table 4 Comparison analysis of WBC after Da and Pm bites Blood Examination %( Da / Pm ) n ↓ 1.33%/0 1(≤ 0.5:1)/0 WBC Normal(3.5–9.5×10 9 /L) 57.34%/38.98% 43/23 ↑ 41.33%/61.02% 31/36 ↓ 4% /1.69% 3/1 Neutrophil Normal(50%-70%) 48%/37.29% 36/22 ↑ 48%/61.02% 36/36 ↓ 41.33%/25.42% 31(≤ 0.5:31)/15(≤ 0.5:15) Hb Normal(110-160g/L) 57.33%/74.58% 43/44 ↑ 1.33%/0 1/0 ↓ 14.67%/3.39% 11(≤ 0.5:2)/2 PLT Normal((100–300)×10 9 /L) 82.67%/96.61 62/57 ↑ 2.67%/0 2/0 ↓ decreased; ↑ increased. ≤0.5: fold change ≤ 0.5. Effect of Deinagkistrodon acutus vs. Protobothrops mucrosquamatus snakebite on blood electrolytes The blood potassium levels in 72% ( Da ) and 71.19% ( Pm ) were normal, while a slight decrease was observed in 28% ( Da ) and 28.81% ( Pm ) of the patients. The sodium levels were normal in 100% ( Da ) and 96.61% ( Pm ) of patients. The calcium levels of Da and Pm bite patients were normal in 84% and 83.05% of the cohort group. However, a slight decline was observed in 16% ( Da ) and 16.95% ( Pm ) individuals. Similar results were obtained for blood magnesium levels (Normal: 68% ( Da ) vs. 66.10% ( Pm ); 30.67%↓ ( Da ) vs. 33.90%↓ ( Pm ). The above results showed that the venom of both the species had similar effects on K + , Na + , Ca 2+ and Mg 2+ (the most affected) in vivo (Table 5 ). Table 5 Comparison analysis of K + after Da and Pm bites Blood Electrolytes %( Da / Pm ) n ↓ 28%/28.81% 21(≤ 0.5:21)/17(≤ 0.5:17) K + Normal(3.5-5.5mmol/L) 72%/71.19% 54/42 ↑ 0/0 0/0 ↓ 0/0 0/0 Na + Normal(135-145mmol/L) 100%/96.61% 75/57 ↑ 0/3.39% 0/2 ↓ 16%/16.95% 12(≤ 0.5:5)/10 Ca 2+ Normal(2.25-2.75mmol/L) 84%/83.05% 63/49 ↑ 0/0 0/0 ↓ 30.67%/33.90% 23(≤ 0.5:9)/20(≤ 0.5:8) Mg 2+ Normal(0.8-1.0mmol/L) 68%/66.10% 51/39 ↑ 1.33%/0 1/0 ↓ decreased; ↑ increased.≤0.5: fold change ≤ 0.5. Effect of Deinagkistrodon acutus vs. Protobothrops mucrosquamatus snakebite on heart, liver, and kidney functions The CK-Mb values were normal in 73.33% ( Da ) and 62.71% ( Pm ) of the patients in this group, and other individuals had increased CK-Mb levels to varying degrees. In terms of liver function, the normal rates of ALT and AST in snakebite patients were 86.67% ( Da ) vs. 91.53% ( Pm ) and 78.67% ( Da ) vs. 77.97% ( Pm ), respectively. In terms of LDH and albumin, 90.67% ( Da ) vs. 83.05% ( Pm ), 90.67% ( Da ) vs. 83.05% ( Pm ), respectively, had normal rates (Table 6 ). The above results showed that the CK-Mb, AST level in patients with snake injuries were the most abnormal, while the impact on ALT, LDH, and albumin was relatively smaller. Table 6 Comparison analysis of CK-Mb after Da and Pm bites Heart/Liver/Kidney functions %( Da / Pm ) n ↓ 0/0 0/0 CK-Mb Normal(0-25U/L) 73.33%/62.71% 55/37 ↑ 26.67%/37.29% 20/22 ↓ 5.33% /0 4/0 ALT Normal(0-40U/L) 86.67% /91.53% 65/54 ↑ 8%/8.47% 6/5 ↓ 2.67%/1.69% 2/1 AST Normal(0-40U/L) 78.67%/77.97 59/46 ↑ 18.67%/20.34% 14/12 ↓ 0/0 0/0 LDH Normal(100-300U/L) 90.67%/83.05% 68/49 ↑ 9.33%/16.95 7/10 ↓ 6.67%/16.95% 5/10 Albumin Normal(40-55g/L) 90.67%/83.05% 68/49 ↑ 2.67%/0 2/0 ↓ decreased; ↑ increased. Discussion There are about 2500 species of snakes globally[ 24 ]. Snakebite is becoming a worldwide public health threat, and the clinical outcome of snakebite victims is related to the venomous snake species, wound depth, age, sex, and general health status. In Guangdong Province, the green pit vipe r, Bungarus multicinctus , Naja atra , and DeinDeinagkistrodon acutus were considered to be the most medically important[ 21 ]. In Chongqing, China, the main venomous snake specie is Trimeresurus mucrosquamatus [ 22 ]. In the present study, 177 patients with venomous snakebites were admitted to the epidemiological study and physiological analysis. Deinagkistrodon acutus (42.37%), Protobothrops mucrosquamatus (33.33%), and Naja atra (16.38%). The age of snakebite victims ranged from 13 to 99 years old, with 51–60 years old as the majority (29.38%), followed by 61–70 years old (23.16%). The majority of the snake bite victims were middle-aged and elderly, there are some specific traditional agricultural activities in this group that involves greater exposure, our data was consistent with the previous study [ 25 ]. Due to diverse agricultural activities, snakebites mainly occurred in fields, house neighborhood areas, and mountains, accounting for 40.11%, 37.85%, and 14.69%, respectively. Our data inditates that the people in those related area should pay more attention to protection when they go out to work. This is consistent with the results reported in previous study[ 26 ]. Deinagkistrodon acutus is one of the most common venomous snakes in China[ 27 ] and is used in traditional Chinese herbal medicine based on its immunological regulation, anti-tumor, anti-inflammatory and analgesic effects[ 28 ]. Its venom leads to endotoxemia[ 29 ], coagulopathy[ 30 ], defribination and anticoagulation[ 31 , 32 ]. Snakebite may lead to tissue inflammation, edema, necrosis, hemorrhage, and clotting abnormalities[ 33 ]. In clinical practice, some patients have various complications, including renal insufficiency, acute pulmonary thrombo-embolism, and multiple organ failure, which endanger their lives[ 34 , 35 ]. Protobothrops mucrosquamatus is a medically important species of pit viper with a wide geographic distribution in southeast asia[ 36 ], having a triangular head (shaped like a soldering iron) and tube teeth containing neurotoxins and blood circulation toxins, mucetin and stejnulxin that induce the aggregation of both mammalian platelets and avian thrombocytes, leading to acute cerebral ischemia[ 37 ]. The toxin is a TTX-R type sodium channel blocker, which has no obvious effect on the TTX-S type sodium channel. In addition, its venom also contains the inhibiting components of HVA and LVA-type calcium channels. Protobothrops mucrosquamatus bite causes severe wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and acute renal failure, even death[ 38 ]. Venom-induced coagulation dysfunction is the important systemic effect of snake envenoming and are most likely to contribute to AKI development [ 39 ]. Agkisacucetin, protein C, and Trimucrotoxin (TmCT) play a critical role in coagulation and anticoagulation(bleeding time and induced transient thrombocytopenia)[ 40 , 41 ]. However, in this study, a huge percentage of coagulation function tests (PT, 69.33% (Da) and 91.53% ( Pm ); APTT, 64% (Da) and 96.61% ( Pm ); fibrinogen, 44% (Da) and 77.97% ( Pm )) were normal. For Pm snakebite patients, we observed higher normal rate, the possible reason is that different snake venom possesses different component. When fibrinogen level falls below 1.5g/L, immediate corrective supplementation is deemed essential[ 42 ]. We observed that 11 snakebite patients (Da) possessed less than 0.5 fold decreasement (≤ 1g/L) for fibrinogen. Our data also showed that a certain percentage of snakebite patients with decreased electrolyte levels: 28% (Da)/28.81% ( Pm ), blood potassium;16%(Da)/16.95%( Pm ), blood calcium, and 30.67%(Da)/33.90% ( Pm ), blood magnesium, respectively. This is similar to the previous data in canine blood mixed with venom[ 43 ]. Previous studies have shown that magnesium involved in PLT aggregation, blood clotting, and thrombosis[ 44 ]. Here, we observed the lowest normal rate ( Da / Pm : 68%/66.10%) for blood potassium. This indicates that Da and Pm affect blood magnesium severely, but the underlying mechanism how the potassium affects coagulation need further elucidation. The abnormality of heart, liver, and kidney function caused by snakebites can be life-debilitating. Calloselasma rhodostoma (Malayan pit viper) envenoming results in cardiovascular disturbances, hepatotoxicity and nephrotoxicity[ 45 ]. Almurtada et al . reported that snakebite by cerastes or desert horned viper resulted in cardiotoxicity. Viperidae and Elapidae venom caused life-threatening acute kidney injury[ 13 ]. In 2012, researchers from India showed that the incidence of acute kidney injury after venomous snakebite was 43.27%[ 46 ]. Our data showed that normal levels of LDH, 90.67%(Da)/83.05%(Da); albumin, 90.67%(Da)/83.05%(Da) level were recorded, while 73.33%(Da)/62.71%( Pm )of snakebite victims showed normal CK-Mb levels, 78.67%(Da)/77.97(Da) for AST level. Therefore, special attention is needed to prevent complications due to abnormal CK-Mb and AST in patients with snakebite caused by these two species. Our data reiterates the importance of paying attention to the adverse reactions caused by abnormal CK-Mb and AST in snakebite victims. In comparison, analysis of prothrombin time ( Deinagkistrodon acutus vs. Protobothrops mucrosquamatus ), Deinagkistrodon acutus caused much more prothrombin time elongation (30.66% vs 8.47%). Therefore the emphasis on coagulation function, especially the prothrombin time caused by Deinagkistrodon acutus is necessary. For routine blood examination, blood electrolytes, heart, liver, and kidney functions, both Deinagkistrodon acutus and Protobothrops mucrosquamatus bites showed similar effects. There are also some limitations exist due to certain data lost, including occupation of study participants, anatomic site of bites. A larger sample size is also needed for further research. Conclusions In summary, the majority of the snakebites in China Northern Guangxi Zhuang Autonomous Region were from Deinagkistrodon acutus ( Da ) and P rotobothrops mucrosquamatus ( Pm ), mostly occurs in fields/neighboring houses/ mountains. Most bite victims were between 50–70 years old. Da and Pm bites showed marked physiological variation. Our results emphasize that the treatment and monitoring after snakebites should be comprehensive and personalized, targeted to prevent and control snakebite-related disease. Abbreviations Da : Deinagkistrodon acutus; Pm : Protobothrops mucrosquamatus; WBC: white blood cells; CK-Mb: CreatineKinase-MB; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LDH: Lactate dehydrogenase; NGAL: neutrophil gelatinase-associated lipocalin; PT: prothrombin time; APTT: partial active thromboplastin time; FIB: fibrinogen; PLT: platelet; TmCT: Trimucrotoxin. Declarations Acknowledgements We acknowledge the contribution of all the patients, health care workers and study team who participated in this study. Author Contributions YongLi: Original draft preparation, Formal analysis, Project administration, Funding acquisition. Guifen Zeng: Clinical information acquisition, Formal analysis.Lantao Gu: Formal analysis.Bin Luo: Formal analysis. Suwan Mu: Formal analysis. Miaoling Wei: Formal analysis. Liuqing Wei: Formal analysis. Honghao Yu (Correspondence): Review and editing, Project administration, Visualization, Funding acquisition. Baoling Xu (Correspondence): Review and editing, Project administration, Visualization, Funding acquisition, Supervision. All authors reviewed the manuscript. Funding This work was supported by the National Natural Science Foundation of China (32260166), Guangxi Science and Technology Base and Talent Project (2019AC20357), National College Students' Innovation and Entrepreneurship Training Program（202310601047, 202210601046）. Data Availability The data are available from the corresponding author on reasonable request. Ethics approval and consent to participate This retrospective study on snake venom has been approved by the Ethics Committee of Guilin Medical University (Ethics number: GLMC20230751) and the Ethics Committee of the Second Affiliated Hospital of Guilin Medical University. The study complies with relevant Chinese laws and ethical guidelines. Data were collected from routine clinical procedures and anonymized. Patients' names were not included, ensuring confidentiality. As the data come from routine treatments, patients have already consented through standard procedures. They receive written information about data collection and can opt out. Informed consent was waived by the approving ethics committees. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Author details 1 School of Intelligent Medicine and Biotechnology, Guilin Medical University, Guilin, PR China. 2 Department of Emergency Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, PR China. 3 Department of Laboratory Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, PR China. 4 Key Laboratory of Medical Biotechnology and Translational Medicine (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, Guilin, PR China. 5 Sichuan Huihui Software Co., Ltd, Mianyang, PR China. References Kumar KGS, E D, K A: Snake Bite Envenomation North Kerala Experience . 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Qinghua L, Xiaowei Z, Wei Y, Chenji L, Yijun H, Pengxin Q, Xingwen S, Songnian H, Guangmei Y: A catalog for transcripts in the venom gland of the Agkistrodon acutus: identification of the toxins potentially involved in coagulopathy . Biochem Biophys Res Commun 2006, 341 (2):522-531. Huang J, Fan H, Yin X, Huang F: Isolation of a Novel Metalloproteinase from Agkistrodon Venom and Its Antithrombotic Activity Analysis . Int J Mol Sci 2019, 20 (17). Li H, Huang Y, Wu X, Wu T, Cao Y, Wang Q, Qiu Y, Fu W, Zhang Q, Pang J: Effects of hemocoagulase agkistrodon on the coagulation factors and its procoagulant activities . Drug Des Devel Ther 2018, 12 :1385-1398. Huang F, Zhao S, Tong F, Liang Y, Le Grange JM, Kuang W, Zhou Y: Unexpected death in a young man associated with a unilateral swollen leg: Pathological and toxicological findings in a fatal snakebite from Deinagkistrodon acutus (Chinese moccasin) . J Forensic Sci 2021, 66 (2):786-792. Lin X, Liang XX, Tang JJ, Chen JS, Qiu PX, Yan GM: The effect of the fibrinolytic enzyme FIIa from Agkistrodon acutus venom on acute pulmonary thromboembolism . Acta Pharmacol Sin 2011, 32 (2):239-244. Matsumura M, Sato T: Rhabdomyolysis and acute renal failure after poisonous snake (Agkistrodon halys blomhoffii) bite . Intern Med 2001, 40 (6):551. Yeh YT, Chen MH, Chang JC, Fan JS, Yen DH, Chen YC: Protobothrops mucrosquamatus Bites to the Head: Clinical Spectrum from Case Series . Am J Trop Med Hyg 2018, 99 (3):753-755. Tian H, Liu M, Li J, Xu R, Long C, Li H, Mwangi J, Lu Q, Lai R, Shen C: Snake C-Type Lectins Potentially Contribute to the Prey Immobilization in Protobothrops mucrosquamatus and Trimeresurus stejnegeri Venoms . Toxins 2020, 12 (2). Mao YC, Liu PY, Chiang LC, Lee CH, Lai CS, Lai KL, Lin WL, Su HY, Ho CH, Doan UV et al : Clinical manifestations and treatments of Protobothrops mucrosquamatus bite and associated factors for wound necrosis and subsequent debridement and finger or toe amputation surgery . Clin Toxicol (Phila) 2021, 59 (1):28-37. Wedasingha S, Isbister G, Silva A: Bedside Coagulation Tests in Diagnosing Venom-Induced Consumption Coagulopathy in Snakebite . Toxins 2020, 12 (9). Sun Y, Bao PJ, Zhang GB: Purification and characterization of Protein C activator from Agkistrodon acutus Venom . Preparative biochemistry & biotechnology 2020, 50 (9):907-914. Tsai IH, Wang YM, Hseu MJ: Mutagenesis analyses explore residues responsible for the neurotoxic and anticoagulant activities of Trimucrotoxin, a pit-viper venom Asn6-phospholipase A2 . Biochimie 2011, 93 (2):277-285. Sharma H, Sharma N, An SSA: Unique Bioactives from Zombie Fungus ( ) as Promising Multitargeted Neuroprotective Agents . Nutrients 2024, 16 (1). Walton RM, Brown DE, Hamar DW, Meador VP, Horn JW, Thrall MA: Mechanisms of echinocytosis induced by Crotalus atrox venom . Vet Pathol 1997, 34 (5):442-449. Zhong T, Zhang J, Chen S, Chen S, Deng K, Guan J, Yang J, Lv R, Liu Z, Liu Y et al : MAGNESIUM SULFATE AMELIORATES HISTONE-INDUCED COAGULATION DYSFUNCTION AND LUNG DAMAGE IN MICE . Shock (Augusta, Ga) 2024, 61 (1):132-141. Khimmaktong W, Nuanyaem N, Lorthong N, Hodgson WC, Chaisakul J: Histopathological Changes in the Liver, Heart and Kidneys Following Malayan Pit Viper (Calloselasma rhodostoma) Envenoming and the Neutralising Effects of Hemato Polyvalent Snake Antivenom . Toxins 2022, 14 (9). Paul J, Dasgupta S: Early prediction of acute kidney injury by clinical features of snakebite patients at the time of hospital admission . N Am J Med Sci 2012, 4 (5):216-220. Additional Declarations No competing interests reported. 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Yu","email":"","orcid":"","institution":"Guilin Medical University","correspondingAuthor":false,"prefix":"","firstName":"Honghao","middleName":"H.","lastName":"Yu","suffix":""},{"id":337742540,"identity":"ee65994f-0e64-49ea-ac4b-b15c70aff949","order_by":8,"name":"Baoling L. Xu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACNv7+BwckDGx42NibDxCnhU/iDOMDi4o0GT6eYwnEaZFjyGE2qDhzyEZOIseASIcxnD0mcbPtAA+bRM7HG28Y7OR0GwhpYe5Lk5zZdoeHjeftZss5DMnGZgcI2nLATFqy7RnQ+7nbpHkYDiRuI6wlwUz6b9thHjaGnGfEaskxNpA4A9TCkcNGpBaJY4kPJCrSgH45Zmw5x4AIv8j3Nx8ARaW9fHvzwxtvKuzkCGpBARI8REYNshZSdYyCUTAKRsGIAADlEj9R91My0gAAAABJRU5ErkJggg==","orcid":"","institution":"The Second Affiliated Hospital of Guilin Medical University","correspondingAuthor":true,"prefix":"","firstName":"Baoling","middleName":"L.","lastName":"Xu","suffix":""}],"badges":[],"createdAt":"2024-07-30 14:20:45","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4829486/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4829486/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":72961522,"identity":"458a80b6-bb37-4a41-9d97-71797e22f4c7","added_by":"auto","created_at":"2025-01-04 13:16:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1997154,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4829486/v1/05ab8ef1-8c6b-469e-8799-6423432abbef.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Epidemiological Study and Physiological Analysis of Snakebite Envenoming in China Northern Guangxi Zhuang Autonomous Region-a Retrospective Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSnakebite is a worldwide public health problem, posing an enormous threat to human life in many countries[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], and causing huge social costs[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Every year, 1.8 to 2.5\u0026nbsp;million venomous snakebites occur worldwide, causing at least 1,00,000 deaths[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Lack of precise first aid knowledge and access to quality care lead to severe fatality in human beings following a snakebite[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. The clinical outcome of patients bitten by venomous snakes depends on the type of venomous snake, the depth of the wound, the amount of venom injected, the patient's age, sex, and general health status. Snakebite may also cause a range of clinical sequelae, including thrombosis and neuromuscular paralysis[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe venom secreted by the venom gland of a venomous snake has a variety of active ingredients: polypeptides, and enzymes, making them clinically challenging and scientifically fascinating[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. After a snakebite, these toxic substances quickly enter the human body through the lymphatic system and bloodstream to cause poisoning, which damages multiple organs. Snake venom Phospholipase-A2 causes intravascular hemolysis, producing a large amount of hemoglobin that blocks renal tubules[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It is also associated with the proliferation and de-differentiation of renal tubular epithelial cells[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Snake venom can directly damage the epithelial cells of renal tubules, accelerating the damage to the kidney[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The snake venom contains active proteolytic enzymes that coagulate fibrinogen and damage the blood vessel wall, causing serious bleeding and tissue destruction[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Clinically, neutrophil gelatinase-associated lipocalin (NGAL) showed diagnostic value for renal replacement therapy after snakebite-induced acute kidney injuries[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Interestingly, numerous studies reported that snake venom also has protective effects on acute and chronic nephropathy, in addition, snake venom can also cause hemorrhage, muscular and genetic damage[\u003cspan additionalcitationids=\"CR17 CR18 CR19\" citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAccording to the data from the China Association for Disaster \u0026amp; Emergency Rescue Medicine, 47 species of venomous snakes are distributed in China. In Guangdong Province (near Guangxi Zhuang Autonomous Region), the \u003cem\u003egreen pit viper\u003c/em\u003e, \u003cem\u003eBungarus multicinctus\u003c/em\u003e, \u003cem\u003eNaja atra\u003c/em\u003e, and \u003cem\u003eDeinDeinagkistrodon acutus\u003c/em\u003e were considered to be the most medically important[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In Chongqing, China, the main venomous snake specie is \u003cem\u003eTrimeresurus mucrosquamatus\u003c/em\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In addition, there are more than 20 snake species are venomous in Taiwan (subtropical region), including \u003cem\u003eBungarus multicinctus\u003c/em\u003e and \u003cem\u003eNaja atra\u003c/em\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, no systematic report of snake injuries in China Northern Guangxi Zhuang Autonomous Region until now.\u003c/p\u003e \u003cp\u003eNorthern Guangxi is densely covered with well-developed traditional agricultural land, ditches, and rivers, serving as a snake reserve. Venomous snakebites are a global challenge as they cause clinical dysfunction that ranges from local to systemic levels. Therefore a systematic report of snake injuries in this area is necessary. Accordingly, we have summarized and analyzed the epidemiology, physiological and biochemical functions of snakebite patients (177 were hospitalized in our emergency department from April 2019 to December 2021) from the Second Affiliated Hospital of Guilin Medical University in northern Guangxi. This study aims to provide a reference for the specific diagnosis and treatment of snakebites in this area.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eData collection\u003c/h2\u003e \u003cp\u003e177 patients with snakebites were hospitalized in emergency department from April 2019 to December 2021, aged 13\u0026ndash;99 years. These patients were divided into ten age groups. The changes in blood coagulation function, blood routine test, electrolyte, liver, heart, and kidney functions were summarized and analyzed according to snake species. No victim death recorded, no victim survived with disability. No victims used Chinese traditional/herbal medicine before hospital presentation. 81.92% victims received antivenom administration, and most were treated within six hours after bites.\u003c/p\u003e \u003cp\u003elaboratory tests were carried out 24 hours after the snakebite\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eDiagnostic basis\u003c/h2\u003e \u003cp\u003e(1) Snake species identification: Identification of snake species was either by the snake capture and subsequent confirmation in the hospital based on its characteristic features such as shape, or by snake species brought to the hospital. Snake identification involved herpetologists and senior clinical doctors in this area.\u003c/p\u003e \u003cp\u003e(2) Wound condition: Generally, several tooth marks can be seen, having a shape of \"..\", with a spacing of 0.5\u0026ndash;1.5 cm. The symptoms include local swelling, pain, ecchymosis, bleeding around the wound, and swollen and tender lymph nodes.\u003c/p\u003e \u003cp\u003e(3) Clinical condition at the time of hospitalization: At the time of hospitalization, victims with clear consciousness, vital snake bites signs, swelling, wound pain at the site of bite. The hospital examination showed that the white blood cells (WBC) increased and the proportion of neutrophils increased, often accompanied by a decrease in prothrombin time (PT), activated Partial thromboplastin time (APTT), fibrinogen (FIB), platelet (PLT), electrolyte, urine protein, liver function abnormalities, etc.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were extracted from medical records of patients (Department of Emergency Medicine, The Second Affiliated Hospital of Guilin Medical University). Data collectors trained (had access to the snakes/images) on snake identification and further analyzed using PSPP software (Free Software Foundation, Inc.). The clinical characteristics of the 177 patients with snakebites was presented using descriptive statistics. Categorical variables were described by counts and percentage.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eSnake species/Location of snakebites and demographic details\u003c/h2\u003e \u003cp\u003eTo master the species proportion of the snakebites in northern Guangxi, China, we analyzed the snake species bite marks in 177 snakebite patients. The results showed that the major bites were from \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e and \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e, respectively, accounting for 42.37% and 33.33% of the total injury rate (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Therefore, in northern Guangxi, the prevention and treatment of snake injuries should focus on \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e and \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e bites.\u003c/p\u003e \u003cp\u003eMost snakes thrive in ditches, rivers, grassland, and other places. Therefore, venomous snakebites often occur during fieldwork or field operations. According to our data, 40.11% of snakebites occur in fields, 37.85% in areas neighboring houses, and 14.69% in mountains. In addition, there are also some injury rates in factory buildings, riverside, residential areas, and campus, which are 2.82%, 2.82%, 1.13%, and 0.56%, respectively (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe majority of bite victims were 51\u0026ndash;60 years of age (29.38%), 61\u0026ndash;70 years of age (23.16%). The mean age was 57.32\u0026thinsp;\u0026plusmn;\u0026thinsp;15.12 years (range 13\u0026ndash;99 years). There were 120 (67.80%) male victims, while 57 (32.20%) were females. For 93.22% of the patients, the site of bite was in the lower limbs, 6.21% in upper limbs and in 0.56% cases, it was in the head region. All the patients were conscious (100%) at the time of presentation to emergency room. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSpecies/Location of snakebites\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eSpecies/Location\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e42.37%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e\u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e33.33%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecies\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eNaja atra\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e16.38%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eBungarus multicinctus\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e3.95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eTrimeresurus stejnegeri\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e3.95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFields\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e40.11%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse/neighbouring area\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e37.85%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMountains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e14.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLocation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactory buildings\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRiverside\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e2.82%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResidential areas\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e1.13%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCampus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e0.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDistribution of victims Age/Gender etc.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eVictims Age/Gender distribution, etc.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003en(male/female)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0(0/0)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3(1/2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;30\u003c/p\u003e \u003cp\u003e31\u0026ndash;40\u003c/p\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003cp\u003e51\u0026ndash;60\u003c/p\u003e \u003cp\u003e61\u0026ndash;70\u003c/p\u003e \u003cp\u003e71\u0026ndash;80\u003c/p\u003e \u003cp\u003e81\u0026ndash;90\u003c/p\u003e \u003cp\u003e91\u0026ndash;100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e5.65%\u003c/p\u003e \u003cp\u003e12.99%\u003c/p\u003e \u003cp\u003e15.25%\u003c/p\u003e \u003cp\u003e29.38%\u003c/p\u003e \u003cp\u003e23.16%\u003c/p\u003e \u003cp\u003e9.04%\u003c/p\u003e \u003cp\u003e2.26%\u003c/p\u003e \u003cp\u003e0.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10(7/3)\u003c/p\u003e \u003cp\u003e23(20/6)\u003c/p\u003e \u003cp\u003e27(22/5)\u003c/p\u003e \u003cp\u003e52(30/22)\u003c/p\u003e \u003cp\u003e41(28/13)\u003c/p\u003e \u003cp\u003e16(13/3)\u003c/p\u003e \u003cp\u003e4(2/2)\u003c/p\u003e \u003cp\u003e1(0/1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e67.80%\u003c/p\u003e \u003cp\u003e32.20%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e120\u003c/p\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eInjury site\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUpper limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6.21%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLower limb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e93.22%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eConsciousness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eConscious\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAltered sensorium\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eOutcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAlive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e100%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDead\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLeft against medical advice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of blood coagulation function between patients injured by\u003c/b\u003e \u003cb\u003eDeinagkistrodon acutus\u003c/b\u003e \u003cb\u003eand\u003c/b\u003e \u003cb\u003eProtobothrops mucrosquamatus\u003c/b\u003e\u003c/p\u003e \u003cp\u003eOur research concluded that the two species of snakes that cause the most injuries in northern Guangxi are \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e (\u003cem\u003eDa\u003c/em\u003e) and \u003cem\u003eProtobothrops mucrosquamatus (Pm)\u003c/em\u003e. To further clarify the similarities and differences of the effects of these two kinds of snakes on physiological and biochemical indicators of the body, we compared and analyzed the changes in coagulation function, blood routine, electrolytes, liver, heart, and kidney functions of 75 patients with \u003cem\u003eDa\u003c/em\u003e and 59 patients with \u003cem\u003ePm bites\u003c/em\u003e. In terms of blood coagulation function, 69.33% (\u003cem\u003eDa\u003c/em\u003e) and 91.53% (\u003cem\u003ePm\u003c/em\u003e) patients had normal PT(Prothrombin Time). A significant number of patients (30.66%) with \u003cem\u003eDa\u003c/em\u003e bites had increased prothrombin time, while \u003cem\u003ePm\u003c/em\u003e only caused 8.47% of the individuals to have such an effect. The Activated Partial Thromboplatin Time (APTT) values of 64% (\u003cem\u003eDa\u003c/em\u003e) and 96.61% (\u003cem\u003ePm\u003c/em\u003e) patients were normal. While 30.66% of \u003cem\u003eDa\u003c/em\u003e bite victims had APTT prolongation to varying degrees, only 3.39% of patients with \u003cem\u003ePm\u003c/em\u003e bites had such a variance; The fibrinogen levels in 44% of the \u003cem\u003eDa\u003c/em\u003e bite victims and 77.97% of the \u003cem\u003ePm\u003c/em\u003e injured individuals was normal. However, a decline in this indicator was more pronounced in patients with \u003cem\u003eDa\u003c/em\u003e bite (49.33%) in comparison to \u003cem\u003ePm\u003c/em\u003e bite victims (13.56%). In addition, 17 snakebites (\u003cem\u003eDa\u003c/em\u003e) possessed more than 2 fold increasement for PT, 11 snakebites(\u003cem\u003eDa\u003c/em\u003e) possessed less than 0.5 fold decreasement for fibrinogen. (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). Thus our data on blood coagulation function shows that the effect of \u003cem\u003eDa\u003c/em\u003e snakebite on individuals leads to prolongation of PT and APTT, and a decrease in fibrinogen level, while for the individuals with \u003cem\u003ePm\u003c/em\u003e snakebite, this effect is significantly weakened.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison analysis of prothrombin time after \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bites\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCoagulation function\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%(\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(10-16s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.33%/91.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52/54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.66%/8.47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(\u0026ge;\u0026thinsp;2:17)/5(\u0026ge;\u0026thinsp;2:2)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.33%/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4(\u0026le;\u0026thinsp;0.5:4)/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAPTT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(34-40s)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64%/96.61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 /57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.66%/3.39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23/2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49.33%/13.56%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e37(\u0026le;\u0026thinsp;0.5:11)/8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFibrinogen\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(2-4g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44%/77.97%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33/46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.67%/8.47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026darr; decreased; \u003cb\u003e\u0026uarr;\u003c/b\u003e increased. \u0026ge;2:fold change\u0026thinsp;\u0026ge;\u0026thinsp;2; \u0026le;0.5: fold change\u0026thinsp;\u0026le;\u0026thinsp;0.5.\u003c/p\u003e \u003cp\u003e \u003cb\u003eComparison of routine blood examination between patients bitten by\u003c/b\u003e \u003cb\u003eDeinagkistrodon acutus\u003c/b\u003e \u003cb\u003evs.\u003c/b\u003e \u003cb\u003eProtobothrops mucrosquamatus\u003c/b\u003e\u003c/p\u003e \u003cp\u003eIn terms of routine blood test, the influence of \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bites on WBC count showed an upward trend, with percentages of 41.33% and 61.02%, respectively. A similar trend was observed for neutrophils(48%/61.02%), as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. The PLT count was normal in 82.67% (\u003cem\u003eDa\u003c/em\u003e) and 96.61% (\u003cem\u003ePm\u003c/em\u003e) of the patients, while others showed up- or down-regulation in different proportions. The Hb content was normal in 57.33% (\u003cem\u003eDa\u003c/em\u003e) and 74.58% (\u003cem\u003ePm\u003c/em\u003e) of the individuals, while others showed varying degrees of decline or increase (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison analysis of WBC after \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bites\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBlood Examination\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%(\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.33%/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1(\u0026le;\u0026thinsp;0.5:1)/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWBC\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(3.5\u0026ndash;9.5\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.34%/38.98%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43/23\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.33%/61.02%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31/36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4% /1.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3/1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeutrophil\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(50%-70%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48%/37.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36/22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e48%/61.02%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e36/36\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.33%/25.42%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e31(\u0026le;\u0026thinsp;0.5:31)/15(\u0026le;\u0026thinsp;0.5:15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(110-160g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e57.33%/74.58%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43/44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.33%/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026darr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.67%/3.39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11(\u0026le;\u0026thinsp;0.5:2)/2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePLT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal((100\u0026ndash;300)\u0026times;10\u003csup\u003e9\u003c/sup\u003e/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e82.67%/96.61\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e62/57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.67%/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026darr; decreased; \u003cb\u003e\u0026uarr;\u003c/b\u003e increased. \u0026le;0.5: fold change\u0026thinsp;\u0026le;\u0026thinsp;0.5.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEffect of\u003c/b\u003e \u003cb\u003eDeinagkistrodon acutus\u003c/b\u003e \u003cb\u003evs.\u003c/b\u003e \u003cb\u003eProtobothrops mucrosquamatus\u003c/b\u003e \u003cb\u003esnakebite on blood electrolytes\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe blood potassium levels in 72% (\u003cem\u003eDa\u003c/em\u003e) and 71.19% (\u003cem\u003ePm\u003c/em\u003e) were normal, while a slight decrease was observed in 28% (\u003cem\u003eDa\u003c/em\u003e) and 28.81% (\u003cem\u003ePm\u003c/em\u003e) of the patients. The sodium levels were normal in 100% (\u003cem\u003eDa\u003c/em\u003e) and 96.61% (\u003cem\u003ePm\u003c/em\u003e) of patients. The calcium levels of \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bite patients were normal in 84% and 83.05% of the cohort group. However, a slight decline was observed in 16% (\u003cem\u003eDa\u003c/em\u003e) and 16.95% (\u003cem\u003ePm\u003c/em\u003e) individuals. Similar results were obtained for blood magnesium levels (Normal: 68% (\u003cem\u003eDa\u003c/em\u003e) vs. 66.10% (\u003cem\u003ePm\u003c/em\u003e); 30.67%\u0026darr; (\u003cem\u003eDa\u003c/em\u003e) vs. 33.90%\u0026darr; (\u003cem\u003ePm\u003c/em\u003e). The above results showed that the venom of both the species had similar effects on K\u003csup\u003e+\u003c/sup\u003e, Na\u003csup\u003e+\u003c/sup\u003e, Ca\u003csup\u003e2+\u003c/sup\u003eand Mg\u003csup\u003e2+\u003c/sup\u003e (the most affected) \u003cem\u003ein vivo\u003c/em\u003e(Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison analysis of K\u003csup\u003e+\u003c/sup\u003e after \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bites\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eBlood Electrolytes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%(\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28%/28.81%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21(\u0026le;\u0026thinsp;0.5:21)/17(\u0026le;\u0026thinsp;0.5:17)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eK\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(3.5-5.5mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72%/71.19%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54/42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNa\u003csup\u003e+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(135-145mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100%/96.61%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e75/57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/3.39%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16%/16.95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12(\u0026le;\u0026thinsp;0.5:5)/10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCa\u003csup\u003e2+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(2.25-2.75mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84%/83.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63/49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.67%/33.90%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23(\u0026le;\u0026thinsp;0.5:9)/20(\u0026le;\u0026thinsp;0.5:8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMg\u003csup\u003e2+\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(0.8-1.0mmol/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68%/66.10%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e51/39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.33%/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026darr; decreased; \u003cb\u003e\u0026uarr;\u003c/b\u003e increased.\u0026le;0.5: fold change\u0026thinsp;\u0026le;\u0026thinsp;0.5.\u003c/p\u003e \u003cp\u003e \u003cb\u003eEffect of\u003c/b\u003e \u003cb\u003eDeinagkistrodon acutus\u003c/b\u003e \u003cb\u003evs.\u003c/b\u003e \u003cb\u003eProtobothrops mucrosquamatus\u003c/b\u003e \u003cb\u003esnakebite on heart, liver, and kidney functions\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe CK-Mb values were normal in 73.33% (\u003cem\u003eDa\u003c/em\u003e) and 62.71% (\u003cem\u003ePm\u003c/em\u003e) of the patients in this group, and other individuals had increased CK-Mb levels to varying degrees. In terms of liver function, the normal rates of ALT and AST in snakebite patients were 86.67% (\u003cem\u003eDa\u003c/em\u003e) vs. 91.53% (\u003cem\u003ePm\u003c/em\u003e) and 78.67% (\u003cem\u003eDa\u003c/em\u003e) vs. 77.97% (\u003cem\u003ePm\u003c/em\u003e), respectively. In terms of LDH and albumin, 90.67% (\u003cem\u003eDa\u003c/em\u003e) vs. 83.05% (\u003cem\u003ePm\u003c/em\u003e), 90.67% (\u003cem\u003eDa\u003c/em\u003e) vs. 83.05% (\u003cem\u003ePm\u003c/em\u003e), respectively, had normal rates (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e). The above results showed that the CK-Mb, AST level in patients with snake injuries were the most abnormal, while the impact on ALT, LDH, and albumin was relatively smaller.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab6\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 6\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eComparison analysis of CK-Mb after \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bites\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eHeart/Liver/Kidney functions\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e%(\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003en\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCK-Mb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(0-25U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73.33%/62.71%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55/37\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.67%/37.29%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20/22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.33% /0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eALT\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(0-40U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.67% /91.53%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65/54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8%/8.47%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6/5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.67%/1.69%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAST\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(0-40U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e78.67%/77.97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e59/46\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.67%/20.34%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14/12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLDH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(100-300U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.67%/83.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68/49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.33%/16.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7/10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026darr;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.67%/16.95%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5/10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNormal(40-55g/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90.67%/83.05%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68/49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026uarr;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.67%/0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e\u0026darr; decreased; \u003cb\u003e\u0026uarr;\u003c/b\u003e increased.\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThere are about 2500 species of snakes globally[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Snakebite is becoming a worldwide public health threat, and the clinical outcome of snakebite victims is related to the venomous snake species, wound depth, age, sex, and general health status. In Guangdong Province, the \u003cem\u003egreen pit vipe\u003c/em\u003er, \u003cem\u003eBungarus multicinctus\u003c/em\u003e, \u003cem\u003eNaja atra\u003c/em\u003e, and \u003cem\u003eDeinDeinagkistrodon acutus\u003c/em\u003e were considered to be the most medically important[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In Chongqing, China, the main venomous snake specie is \u003cem\u003eTrimeresurus mucrosquamatus\u003c/em\u003e[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In the present study, 177 patients with venomous snakebites were admitted to the epidemiological study and physiological analysis. \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e (42.37%), \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e (33.33%), and \u003cem\u003eNaja atra\u003c/em\u003e (16.38%). The age of snakebite victims ranged from 13 to 99 years old, with 51\u0026ndash;60 years old as the majority (29.38%), followed by 61\u0026ndash;70 years old (23.16%). The majority of the snake bite victims were middle-aged and elderly, there are some specific traditional agricultural activities in this group that involves greater exposure, our data was consistent with the previous study [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Due to diverse agricultural activities, snakebites mainly occurred in fields, house neighborhood areas, and mountains, accounting for 40.11%, 37.85%, and 14.69%, respectively. Our data inditates that the people in those related area should pay more attention to protection when they go out to work. This is consistent with the results reported in previous study[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e is one of the most common venomous snakes in China[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] and is used in traditional Chinese herbal medicine based on its immunological regulation, anti-tumor, anti-inflammatory and analgesic effects[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Its venom leads to endotoxemia[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], coagulopathy[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e], defribination and anticoagulation[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Snakebite may lead to tissue inflammation, edema, necrosis, hemorrhage, and clotting abnormalities[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In clinical practice, some patients have various complications, including renal insufficiency, acute pulmonary thrombo-embolism, and multiple organ failure, which endanger their lives[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e is a medically important species of pit viper with a wide geographic distribution in southeast asia[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e], having a triangular head (shaped like a soldering iron) and tube teeth containing neurotoxins and blood circulation toxins, mucetin and stejnulxin that induce the aggregation of both mammalian platelets and avian thrombocytes, leading to acute cerebral ischemia[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The toxin is a TTX-R type sodium channel blocker, which has no obvious effect on the TTX-S type sodium channel. In addition, its venom also contains the inhibiting components of HVA and LVA-type calcium channels. \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e bite causes severe wound necrosis, coagulopathy, thrombocytopenia, rhabdomyolysis, and acute renal failure, even death[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVenom-induced coagulation dysfunction is the important systemic effect of snake envenoming and are most likely to contribute to AKI development [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Agkisacucetin, protein C, and Trimucrotoxin (TmCT) play a critical role in coagulation and anticoagulation(bleeding time and induced transient thrombocytopenia)[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. However, in this study, a huge percentage of coagulation function tests (PT, 69.33% (Da) and 91.53% (\u003cem\u003ePm\u003c/em\u003e); APTT, 64% (Da) and 96.61% (\u003cem\u003ePm\u003c/em\u003e); fibrinogen, 44% (Da) and 77.97% (\u003cem\u003ePm\u003c/em\u003e)) were normal. For \u003cem\u003ePm\u003c/em\u003e snakebite patients, we observed higher normal rate, the possible reason is that different snake venom possesses different component. When fibrinogen level falls below 1.5g/L, immediate corrective supplementation is deemed essential[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. We observed that 11 snakebite patients (Da) possessed less than 0.5 fold decreasement (\u0026le;\u0026thinsp;1g/L) for fibrinogen. Our data also showed that a certain percentage of snakebite patients with decreased electrolyte levels: 28% (Da)/28.81% (\u003cem\u003ePm\u003c/em\u003e), blood potassium;16%(Da)/16.95%(\u003cem\u003ePm\u003c/em\u003e), blood calcium, and 30.67%(Da)/33.90% (\u003cem\u003ePm\u003c/em\u003e), blood magnesium, respectively. This is similar to the previous data in canine blood mixed with venom[\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Previous studies have shown that magnesium involved in PLT aggregation, blood clotting, and thrombosis[\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]. Here, we observed the lowest normal rate (\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e: 68%/66.10%) for blood potassium. This indicates that \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e affect blood magnesium severely, but the underlying mechanism how the potassium affects coagulation need further elucidation.\u003c/p\u003e \u003cp\u003eThe abnormality of heart, liver, and kidney function caused by snakebites can be life-debilitating. \u003cem\u003eCalloselasma rhodostoma\u003c/em\u003e (Malayan pit viper) envenoming results in cardiovascular disturbances, hepatotoxicity and nephrotoxicity[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]. Almurtada \u003cem\u003eet al\u003c/em\u003e. reported that snakebite by cerastes or desert horned viper resulted in cardiotoxicity. Viperidae and Elapidae venom caused life-threatening acute kidney injury[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In 2012, researchers from India showed that the incidence of acute kidney injury after venomous snakebite was 43.27%[\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e]. Our data showed that normal levels of LDH, 90.67%(Da)/83.05%(Da); albumin, 90.67%(Da)/83.05%(Da) level were recorded, while 73.33%(Da)/62.71%(\u003cem\u003ePm\u003c/em\u003e)of snakebite victims showed normal CK-Mb levels, 78.67%(Da)/77.97(Da) for AST level. Therefore, special attention is needed to prevent complications due to abnormal CK-Mb and AST in patients with snakebite caused by these two species. Our data reiterates the importance of paying attention to the adverse reactions caused by abnormal CK-Mb and AST in snakebite victims.\u003c/p\u003e \u003cp\u003eIn comparison, analysis of prothrombin time (\u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e vs. \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e), \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e caused much more prothrombin time elongation (30.66% vs 8.47%). Therefore the emphasis on coagulation function, especially the prothrombin time caused by \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e is necessary. For routine blood examination, blood electrolytes, heart, liver, and kidney functions, both \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e and \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e bites showed similar effects.\u003c/p\u003e \u003cp\u003eThere are also some limitations exist due to certain data lost, including occupation of study participants, anatomic site of bites. A larger sample size is also needed for further research.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn summary, the majority of the snakebites in China Northern Guangxi Zhuang Autonomous Region were from \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e (\u003cem\u003eDa\u003c/em\u003e) and P\u003cem\u003erotobothrops mucrosquamatus\u003c/em\u003e (\u003cem\u003ePm\u003c/em\u003e), mostly occurs in fields/neighboring houses/ mountains. Most bite victims were between 50\u0026ndash;70 years old. \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bites showed marked physiological variation. Our results emphasize that the treatment and monitoring after snakebites should be comprehensive and personalized, targeted to prevent and control snakebite-related disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cem\u003eDa\u003c/em\u003e: Deinagkistrodon acutus; \u003cem\u003ePm\u003c/em\u003e: Protobothrops mucrosquamatus; WBC: white blood cells; CK-Mb: CreatineKinase-MB; AST: Aspartate aminotransferase; ALT: Alanine aminotransferase; LDH: Lactate dehydrogenase; NGAL: neutrophil gelatinase-associated lipocalin; PT: prothrombin time; APTT: partial active thromboplastin time; FIB: fibrinogen; PLT: platelet; TmCT: Trimucrotoxin.\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe acknowledge the contribution of all the patients, health care workers and study team who participated in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYongLi: Original draft preparation, Formal analysis, Project administration, Funding acquisition. Guifen Zeng: Clinical information acquisition, Formal analysis.Lantao Gu: Formal analysis.Bin Luo: Formal analysis. Suwan Mu: Formal analysis. Miaoling Wei: Formal analysis. Liuqing Wei: Formal analysis. Honghao Yu\u0026nbsp;(Correspondence): Review and editing, Project administration, Visualization, Funding acquisition. Baoling Xu (Correspondence): Review and editing, Project administration, Visualization, Funding acquisition, Supervision. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Natural Science Foundation of China (32260166), Guangxi Science and Technology Base and Talent Project (2019AC20357), National College Students\u0026apos; Innovation and Entrepreneurship Training Program（202310601047, 202210601046）.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis retrospective study on snake venom has been approved by the Ethics Committee of Guilin Medical University (Ethics number: GLMC20230751) and the Ethics Committee of the Second Affiliated Hospital of Guilin Medical University. The study complies with relevant Chinese laws and ethical guidelines.\u003c/p\u003e\n\u003cp\u003eData were collected from routine clinical procedures and anonymized. Patients\u0026apos; names were not included, ensuring confidentiality. As the data come from routine treatments, patients have already consented through standard procedures. They receive written information about data collection and can opt out. Informed consent was waived by the approving ethics committees.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003e School of Intelligent Medicine and Biotechnology, Guilin Medical University, Guilin, PR China.\u003csup\u003e2\u003c/sup\u003e Department of Emergency Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, PR China.\u003csup\u003e3\u003c/sup\u003e Department of Laboratory Medicine, The Second Affiliated Hospital of Guilin Medical University, Guilin, PR China. \u003csup\u003e4\u003c/sup\u003e Key Laboratory of Medical Biotechnology and Translational Medicine (Guilin Medical University), Education Department of Guangxi Zhuang Autonomous Region, Guilin, PR China.\u003csup\u003e5\u003c/sup\u003e Sichuan Huihui Software Co., Ltd, Mianyang, PR China.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKumar KGS, E D, K A: \u003cstrong\u003eSnake Bite Envenomation North Kerala Experience\u003c/strong\u003e. \u003cem\u003eJ Assoc Physicians India \u003c/em\u003e2020, \u003cstrong\u003e68\u003c/strong\u003e(1):86.\u003c/li\u003e\n\u003cli\u003eBawaskar HS, Bawaskar PH: \u003cstrong\u003eSnake bite: prevention and management in rural Indian settings\u003c/strong\u003e. \u003cem\u003eLancet Glob Health \u003c/em\u003e2019, \u003cstrong\u003e7\u003c/strong\u003e(9):e1178.\u003c/li\u003e\n\u003cli\u003eMensah EK, Karikari K, Aikins M, Vanotoo L, Sackey S, Ohuabunwo C, Wurapa F, Sifah TK, Afari E: \u003cstrong\u003eSecondary analysis of snake bite data in the Western Region of Ghana: 2006-2010\u003c/strong\u003e. \u003cem\u003eGhana Med J \u003c/em\u003e2016, \u003cstrong\u003e50\u003c/strong\u003e(2):103-106.\u003c/li\u003e\n\u003cli\u003eWilliams DJ: \u003cstrong\u003eSnake bite: a global failure to act costs thousands of lives each year\u003c/strong\u003e. \u003cem\u003eBMJ \u003c/em\u003e2015, \u003cstrong\u003e351\u003c/strong\u003e:h5378.\u003c/li\u003e\n\u003cli\u003eKim OH, Lee JW, Kim HI, Cha K, Kim H, Lee KH, Hwang SO, Cha YS: \u003cstrong\u003eAdverse Cardiovascular Events after a Venomous Snakebite in Korea\u003c/strong\u003e. \u003cem\u003eYonsei Med J \u003c/em\u003e2016, \u003cstrong\u003e57\u003c/strong\u003e(2):512-517.\u003c/li\u003e\n\u003cli\u003eBhargava S, Kumari K, Sarin RK, Singh R: \u003cstrong\u003eFirst-hand knowledge about snakes and snake-bite management: an urgent need\u003c/strong\u003e. \u003cem\u003eNagoya J Med Sci \u003c/em\u003e2020, \u003cstrong\u003e82\u003c/strong\u003e(4):763-774.\u003c/li\u003e\n\u003cli\u003eSimpson ID, Norris RL: \u003cstrong\u003eThe global snakebite crisis--a public health issue misunderstood, not neglected\u003c/strong\u003e. \u003cem\u003eWilderness Environ Med \u003c/em\u003e2009, \u003cstrong\u003e20\u003c/strong\u003e(1):43-56.\u003c/li\u003e\n\u003cli\u003eSeifert SA, Armitage JO, Sanchez EE: \u003cstrong\u003eSnake Envenomation. 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Snake Antivenom\u003c/strong\u003e. \u003cem\u003eToxins \u003c/em\u003e2022, \u003cstrong\u003e14\u003c/strong\u003e(9).\u003c/li\u003e\n\u003cli\u003ePaul J, Dasgupta S: \u003cstrong\u003eEarly prediction of acute kidney injury by clinical features of snakebite patients at the time of hospital admission\u003c/strong\u003e. \u003cem\u003eN Am J Med Sci \u003c/em\u003e2012, \u003cstrong\u003e4\u003c/strong\u003e(5):216-220.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Snakebite, Epidemiology, Retrospective study","lastPublishedDoi":"10.21203/rs.3.rs-4829486/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4829486/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSnakebite causing huge social costs worldwide. However, no systematic report of snake injuries in China Northern Guangxi Zhuang Autonomous Region until now. In this study, the details of patients with snake bites were retrospectively retrieved and reviewed. Details regarding age, gender, site of snake bites, consciousness, outcome and clinical features at the time of presentation to the hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were extracted from the emergency department (2019-2021), epidemiological study and physiological analysis were performed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOur data showed that the majority of the bites were from \u003cem\u003eDeinagkistrodon acutus(Da) \u003c/em\u003eand\u003cem\u003e Protobothrops mucrosquamatus(Pm)\u003c/em\u003e, respectively, accounting for 42.37% and 33.33%. 40.11% of snakebites occur in fields, 37.85% in areas neighboring houses, and 14.69% in mountains. Most bite victims were between 50 -70 years old (52.54%). The mean age was 57.32±15.12 years. There were 120 (67.80%) male victims, while 57 (32.20%) were females. For 93.22% of the patients, the site of bite was in the lower limbs, 6.21% in upper limbs and in 0.56% cases, it was in the head region. In terms of blood coagulation function, 69.33% (\u003cem\u003eDa\u003c/em\u003e) and 91.53% (\u003cem\u003ePm\u003c/em\u003e) patients had normal Prothrombin Time (PT). A significant number of patients (30.66%) with \u003cem\u003eDa\u003c/em\u003e bites had increased Prothrombin Time, while \u003cem\u003ePm\u003c/em\u003e only caused 8.47% of the individuals to have such an effect. The influence of \u003cem\u003eDa\u003c/em\u003e and \u003cem\u003ePm\u003c/em\u003e bites on White Blood Cells (WBC) count showed an upward trend, with percentages of 41.33% and 61.02%, respectively. A similar trend was observed for neutrophils (48%/61.02%). The venom of both the species had similar effects on K\u003csup\u003e+\u003c/sup\u003e, Na\u003csup\u003e+\u003c/sup\u003e, Ca\u003csup\u003e2+\u003c/sup\u003eand Mg\u003csup\u003e2+\u003c/sup\u003e (Normal rate (\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e): 72%/71.19%, 100%/96.61%, 84%/83.05%, 68%/66.10%) \u003cem\u003ein vivo\u003c/em\u003e. CreatineKinase-MB (CK-M b), Aspartate aminotransferase (AST) level in patients with snake injuries were the most abnormal (Normal rate (\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e): 73.33%/62.71%), while the impact on Alanine aminotransferase (ALT), Lactate dehydrogenase (LDH), and albumin was relatively smaller (Normal rate (\u003cem\u003eDa\u003c/em\u003e/\u003cem\u003ePm\u003c/em\u003e): 86.67%/91.53%, 90.67%/83.05%, 90.67%/83.05%). \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe majority of the snakebites in China Northern Guangxi Zhuang Autonomous Region were from \u003cem\u003eDeinagkistrodon acutus\u003c/em\u003e(\u003cem\u003eDa\u003c/em\u003e) and \u003cem\u003eProtobothrops mucrosquamatus\u003c/em\u003e(\u003cem\u003ePm\u003c/em\u003e), mostly occurs in fields/neighboring houses/ mountains. Most bite victims were between 50-70 years old. \u003cem\u003eDa \u003c/em\u003eand \u003cem\u003ePm\u003c/em\u003e bites showed marked physiological variation, the treatment and monitoring after snakebites should be comprehensive and personalized.\u003c/p\u003e","manuscriptTitle":"Epidemiological Study and Physiological Analysis of Snakebite Envenoming in China Northern Guangxi Zhuang Autonomous Region-a Retrospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-27 12:26:05","doi":"10.21203/rs.3.rs-4829486/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c653cab4-ad8e-4814-88b6-13ca66b15313","owner":[],"postedDate":"August 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-01-04T13:08:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-27 12:26:05","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4829486","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4829486","identity":"rs-4829486","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}