An unexpected clinical case of Dendroaspis Polylepis (Mamba Negra) poisoning in Angola

Abstract

Introduction: Dendroaspis polylepis (black mamba are snakes widely distributed in all the provinces of Angola whose bite leads to cardiopulmonary colapse and death. This article aims to decribe the first case report in Angola as successful treatment of black mamba poisoning. For this, we presente the clinical case of na expatriate patient of chinese nationality female, 49 years old, previously healthy, with biting occurred around 2 pm on 05/27/2019. After the bite, the patient self inflected cuts at the bite level. In the emergency department (8:30)pm Luanda ) sedation, orotracheal intubation and invasive mechanical ventilation were applied, followed by transfer tothe Intensive Care Unit (ICU) around 12h on May 28th 2019, where continuous perfusion sedoanalgesia with Midazolam and Fentanyl. Started the multipurpose sérum, 2 UN 12/12 h, and made a total of 6 UN. Evotution with cardiogenic shock and need for persufed amines. Results: Rapid clinical improvement with extubation on the sixth day of hospitalization and discontinuation of Dobutamine on the next day and improved discharge on the ninth day of hospitalazation. Conclusions: we believe that there were some factors that made this patient´s recovery possible, namely: a) self- inflicted strokes on the instep played an important roel in limiting the absorption of the poison. b) initial hospital treatment with mechanical ventilation and venous access. C) the existence of SAIMIR multipurpose serum. d) Experience of the medical team in the clinical handing of the case. e) Interaction with toxicologist in Snake venoms at diferent stages of the case evolution.