Abbreviation: N/A = not available
On the first day of hospitalization, with the possibility of viral infection, was prescribed Acyclovir tablet 400 mg Tds, and for bacterial infection, Ceftriaxone vial 1 gr Bd , Teicoplanin (Targocid) 400 mg Bd and Meropenem 1 gr Bd intravenous infusion and as well as with probability of snakebite, 5 vials of antivenom via intravenous infusion ,then 6 hours after the first injection, received 5 vials of antivenom and also 2 vials of antivenom every 6 hours in three times as a maintenance dose along with the medications he was already taking. The left upper limb was elevated and a hot water bag was used to reduce stiffness and edema in blister-free areas.
As for the increase in BUN and creatinine in the patient’s blood sample, nephrology consultation was requested. Also following receiving antivenom, decrease in BUN and Creatinine levels and normalization of the level of consciousness, the diagnosis of acute interstitial nephritis (AIN) following snake bite was proposed.
On the second day, the Teicoplanin (Targocid) antibiotic was discontinued and Ciprofloxacin 200 mg IV infusion was replaced. The wound was drained and then Eude Alibore solution, Silver Sulfadiazine, and Zinc Oxide ointments were also used for topical treatment of blisters.
The patient was monitored in the poisoning ward for 3 weeks, after which the fever, hematoma, and skin lesions resolved; the radial pulse is fully and symmetrical in the involved limb. Also, serum levels of BUN, Creatinine, PT, PTT, and INR returned to normal range and the patient was discharged from the hospital by good general condition (figure 1-C, D). The patient gave verbally informed consent in this regard.