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Recurrent coagulopathy after rattlesnake bite requiring continuous intravenous dosing of antivenom.

Hwang CW, Flach FE - Case Rep Emerg Med (2015)

Bottom Line: His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy.His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days.Envenomation may result in latent venom release from soft tissue depots that can last for two weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, P.O. Box 100186, Gainesville, FL 32610-0186, USA.

ABSTRACT
Context. Snakebite envenomation is common and may result in systemic coagulopathy. Antivenom can correct resulting laboratory abnormalities; however, despite antivenom use, coagulopathy may recur, persist, or result in death after a latency period. Case Details. A 50-year-old previously healthy man presented to the emergency department after a rattlesnake bite to his right upper extremity. His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy. His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days. However, over the subsequent two weeks, he continued to have refractory coagulopathy requiring multiple units of antivenom. The coagulopathy finally resolved after starting a continuous antivenom infusion. Discussion. Envenomation may result in latent venom release from soft tissue depots that can last for two weeks. This case report illustrates the importance of close hemodynamic and laboratory monitoring after snakebites and describes the administration of continuous antivenom infusion, instead of multidose bolus, to neutralize latent venom release and correct residual coagulopathy.

No MeSH data available.


Related in: MedlinePlus

Photograph of the eastern diamondback rattlesnake (Crotalus adamanteus) taken by the patient's wife after the patient's snakebite.
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fig1: Photograph of the eastern diamondback rattlesnake (Crotalus adamanteus) taken by the patient's wife after the patient's snakebite.

Mentions: A previously healthy 50-year-old intoxicated man was driving on a road on a May afternoon when he attempted to move a snake off the road with a stick to prevent it from being run over. He was bitten on the dorsum of his right hand by a positively identified 6-foot long diamondback rattlesnake (Figure 1). He immediately called his wife who called emergency medical services (EMS) while he drove home. When EMS arrived, he was found to be confused, nauseated, and vomiting, with altered mental status and intermittent combativeness. Once in the transport vehicle, an intravenous line was established and he was given 25 mg of intravenous (IV) diphenhydramine.


Recurrent coagulopathy after rattlesnake bite requiring continuous intravenous dosing of antivenom.

Hwang CW, Flach FE - Case Rep Emerg Med (2015)

Photograph of the eastern diamondback rattlesnake (Crotalus adamanteus) taken by the patient's wife after the patient's snakebite.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4309308&req=5

fig1: Photograph of the eastern diamondback rattlesnake (Crotalus adamanteus) taken by the patient's wife after the patient's snakebite.
Mentions: A previously healthy 50-year-old intoxicated man was driving on a road on a May afternoon when he attempted to move a snake off the road with a stick to prevent it from being run over. He was bitten on the dorsum of his right hand by a positively identified 6-foot long diamondback rattlesnake (Figure 1). He immediately called his wife who called emergency medical services (EMS) while he drove home. When EMS arrived, he was found to be confused, nauseated, and vomiting, with altered mental status and intermittent combativeness. Once in the transport vehicle, an intravenous line was established and he was given 25 mg of intravenous (IV) diphenhydramine.

Bottom Line: His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy.His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days.Envenomation may result in latent venom release from soft tissue depots that can last for two weeks.

View Article: PubMed Central - PubMed

Affiliation: Department of Emergency Medicine, University of Florida College of Medicine, 1329 SW 16th Street, P.O. Box 100186, Gainesville, FL 32610-0186, USA.

ABSTRACT
Context. Snakebite envenomation is common and may result in systemic coagulopathy. Antivenom can correct resulting laboratory abnormalities; however, despite antivenom use, coagulopathy may recur, persist, or result in death after a latency period. Case Details. A 50-year-old previously healthy man presented to the emergency department after a rattlesnake bite to his right upper extremity. His presentation was complicated by significant glossal and oropharyngeal edema requiring emergent cricothyrotomy. His clinical course rapidly improved with the administration of snake antivenom (FabAV); the oropharyngeal and upper extremity edema resolved within several days. However, over the subsequent two weeks, he continued to have refractory coagulopathy requiring multiple units of antivenom. The coagulopathy finally resolved after starting a continuous antivenom infusion. Discussion. Envenomation may result in latent venom release from soft tissue depots that can last for two weeks. This case report illustrates the importance of close hemodynamic and laboratory monitoring after snakebites and describes the administration of continuous antivenom infusion, instead of multidose bolus, to neutralize latent venom release and correct residual coagulopathy.

No MeSH data available.


Related in: MedlinePlus