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Severe puff adder (Bitis arietans) envenomation with coagulopathy
Eric J Lavonas1, Christian A Tomaszewski, Marsha D Ford
1Division of Medical Toxicology, Department of Emergency Medicine & Carolinas Poison Center, Carolinas Medical Center, Charlotte, North Carolina 28209, USA. eric.lavonas@carolinashealthcare.org
Journal of Toxicology. Clinical Toxicology
|January 1, 2003
Summary
Puff adder envenomation can cause severe coagulopathy and tissue necrosis. Prompt administration of at least 15 vials of antivenom is crucial for managing severe cases.
Area of Science:
- Toxicology
- Herpetology
- Clinical Medicine
Background:
- Puff adder (Bitis arietans) is a venomous snake indigenous to sub-Saharan Africa, causing numerous bites.
- Bites in North America typically involve captive snakes.
- While puff adder venom contains thrombolytic enzymes, severe coagulopathy has not been widely reported.
Observation:
- A severe puff adder envenomation case involving a finger bite is presented.
- The envenomation resulted in significant swelling, local tissue necrosis, hypotension, thrombocytopenia, severe coagulopathy, and hemorrhage.
- The patient required extensive medical intervention, including vasopressors, ventilatory support, leeches, transfusion, and digit amputation.
Findings:
- The patient received 15 vials of South African polyvalent antivenom starting 4.5 hours post-envenomation.
- Antivenom administration led to gradual improvement in hematological abnormalities.
- Despite the severity, the patient experienced a good outcome after a prolonged hospital stay.
Implications:
- Puff adder envenomation can lead to tissue necrosis, hypotension, coagulopathy, thrombocytopenia, and spontaneous bleeding.
- Severe coagulopathy is a potential complication requiring aggressive management.
- Physicians must be prepared to administer substantial doses of antivenom (at least 15 vials) for severe puff adder bites.