A study of 50 cases of mamushi bite experienced at the hospital in these 14 years is reported. The decision whether the antivenin should be administered or not has been controversial, because the rate of the possibility of the serum disease after injected the antivenin is as high as 5 to 10% on the literature. Then, in this hospital the administration of the antivenin is limited for the cases which show hypotention and acute renal failure in 6 hours after injury, the cases which the bite is located in the head and the trunk, or the compromised hosts. Antivenin was used in 3 cases. Steroids were administered in 38 cases. Both steroids and cefalantin were used in 9 cases. All the cases were survived. The effect of the antivenin to reduce the clinical symptoms was not clear, because all the cases treted with the antivenin showed severe local swelling, renal dysfunction, liver dysfunction, and prolongation of the hospital stay. In the cases treated with steroids, or both steroids and cefalantin the clinical course showed better than the cases treated with the antivenin.
Acute renal failure is most commonly observed in the fatal cases of mamushi bite. So the manage ment of renal dysfunction which is induced by a loss of circulatory volume and rhabdomyolysis caused by the toxicity of mamushi is extremely important.