{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T09:43:33Z","timestamp":1785923013876,"version":"3.56.0"},"reference-count":17,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T00:00:00Z","timestamp":1785888000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Initially normal serum creatine kinase (CK) activity may not exclude evolving muscle injury after a snakebite. We evaluated delayed CK elevation, clinical correlates, antivenom exposure, and hospital-day trajectories. Methods: We retrospectively analyzed 499 snakebite encounters at a tertiary hospital in South Korea. Delayed elevation was defined as serum CK \u22651000 U\/L at the first or second follow-up after an initial value &lt;1000 U\/L. Incomplete follow-up was assessed using a lower bound, inverse-probability weighting (IPW), weight truncation, and outcome-model standardization. Results: Among 433 encounters with initially normal CK levels, 258 were retested, and 45 developed delayed elevation (17.4%; 95% confidence interval, 13.3\u201322.5%). The lower bound was 10.4%; sensitivity estimates were 14.3% with standard IPW, 17.2% with truncated IPW, and 17.3% with outcome-model standardization. Antivenom was administered in 196\/499 encounters and was not independently associated with delayed elevation (adjusted odds ratio, 1.35; 95% confidence interval, 0.68\u20132.68). Delayed elevation was associated with local progression (40\/45 vs. 27\/212; p &lt; 0.001), whereas major systemic outcomes were not more frequent (2\/45 vs. 15\/212; p = 0.745). Among 39 encounters measured on hospital days 1\u20135, the median CK level peaked on day 3 and remained above 1000 U\/L on day 5. Conclusions: An initially normal CK level did not exclude later elevation among retested encounters. The population incidence remained uncertain because follow-up was clinically patterned. Delayed elevation was primarily linked to local progression rather than major systemic outcomes. Selective repeat CK testing may complement serial clinical assessments when envenomation remains active.<\/jats:p>","DOI":"10.3390\/jcm15156079","type":"journal-article","created":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:14:46Z","timestamp":1785917686000},"page":"6079","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Delayed Serum Creatine Kinase Elevation After Snakebite: Serial Changes and Clinical Correlates of Myotoxicity in a Korean Tertiary-Care Cohort"],"prefix":"10.3390","volume":"15","author":[{"given":"Young Chan","family":"Park","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8415-0318","authenticated-orcid":false,"given":"Oh Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9664-9186","authenticated-orcid":false,"given":"Kang Hyun","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8169-5750","authenticated-orcid":false,"given":"Sun Ju","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1056\/NEJMra2105228","article-title":"Snake envenomation","volume":"386","author":"Seifert","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17063","DOI":"10.1038\/nrdp.2017.63","article-title":"Snakebite envenoming","volume":"3","author":"Calvete","year":"2017","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e057926","DOI":"10.1136\/bmj-2020-057926","article-title":"Managing snakebite","volume":"376","author":"Ralph","year":"2022","journal-title":"BMJ"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"590","DOI":"10.1093\/trstmh\/trz050","article-title":"Epidemiological profile and outcomes of snakebite injuries treated in emergency departments in South Korea, 2011\u20132016: A descriptive study","volume":"113","author":"Senek","year":"2019","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"45","DOI":"10.22537\/jksct.2022.20.2.45","article-title":"Epidemiology of patients with snake bite or envenomation in emergency department: NEDIS (National Emergency Department Information System)","volume":"20","author":"Lee","year":"2022","journal-title":"J. Korean Soc. Clin. Toxicol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1080\/15563650.2021.1884694","article-title":"Coagulopathy after snake envenomation in South Korea","volume":"59","author":"Moon","year":"2021","journal-title":"Clin. Toxicol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"23503","DOI":"10.1038\/s41598-024-74142-9","article-title":"Clinical characteristics of snake envenomation-related acute kidney injury in South Korea","volume":"14","author":"Moon","year":"2024","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1080\/15563650.2022.2160341","article-title":"Clinical features of snake envenomation in South Korea","volume":"61","author":"Moon","year":"2023","journal-title":"Clin. Toxicol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"12299","DOI":"10.1038\/s41598-026-40454-1","article-title":"Comprehensive molecular characterization and comparison of venom proteins and transcripts in three Gloydius species from South Korea","volume":"16","author":"Park","year":"2026","journal-title":"Sci. Rep."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"5535","DOI":"10.2147\/IJGM.S479291","article-title":"Clinical characteristics and analysis of risk factors associated with rhabdomyolysis in snakebite victims","volume":"17","author":"Wang","year":"2024","journal-title":"Int. J. Gen. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1080\/15563650.2020.1836377","article-title":"Australian snakebite myotoxicity (ASP-23)","volume":"59","author":"Johnston","year":"2021","journal-title":"Clin. Toxicol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Sanhajariya, S., Duffull, S.B., and Isbister, G.K. (2021). Investigating myotoxicity following Australian red-bellied black snake (Pseudechis porphyriacus) envenomation. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0256653"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"793","DOI":"10.1002\/mus.24606","article-title":"Diagnostic evaluation of rhabdomyolysis","volume":"51","author":"Nance","year":"2015","journal-title":"Muscle Nerve"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"285","DOI":"10.5694\/j.1326-5377.2010.tb03909.x","article-title":"Changes in serial laboratory test results in snakebite patients: When can we safely exclude envenoming?","volume":"193","author":"Ireland","year":"2010","journal-title":"Med. J. Aust."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/S0377-1237(02)80140-X","article-title":"Clinical features and management of snake bite","volume":"58","author":"Mehta","year":"2002","journal-title":"Med. J. Armed Forces India"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"e000836","DOI":"10.1136\/tsaco-2021-000836","article-title":"Rhabdomyolysis: An American Association for the Surgery of Trauma Critical Care Committee clinical consensus document","volume":"7","author":"Kodadek","year":"2022","journal-title":"Trauma Surg. Acute Care Open"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1093\/trstmh\/trae072","article-title":"Local swelling in snakebite envenomation: Are we missing something for want of a name?","volume":"119","author":"Kadhiravan","year":"2025","journal-title":"Trans. R. Soc. Trop. Med. Hyg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6079\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T08:43:41Z","timestamp":1785919421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/15\/6079"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,5]]},"references-count":17,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["jcm15156079"],"URL":"https:\/\/doi.org\/10.3390\/jcm15156079","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,5]]}}}