Viper bite with continuous defibrination despite adequate treatment with antivenom

Area of Science:

• Toxicology
• Herpetology
• Clinical Medicine

Background:

• Snakebite envenomation is a significant public health concern globally.
• Viperidae family snakes are responsible for numerous venomous bites in India.
• Polyvalent antivenoms are the mainstay of treatment for viperine snakebites.

Observation:

• A patient presented with continuous defibrination following a viperine snakebite.
• Standard doses and even double doses of available polyvalent antivenom failed to reverse the defibrination.
• No other typical signs of viperine envenomation were observed.

Findings:

• The persistent coagulopathy indicates a potential mismatch between the snake venom and the administered antivenom.
• This refractory defibrination suggests envenomation by a viper species not effectively neutralized by the current Indian polyvalent antivenom.
• The specific viper species responsible remains unidentified but is likely within the Viperidae family.

Implications:

• There is a critical need to reassess the efficacy of existing polyvalent antivenoms against diverse viper populations in India.
• This case highlights the potential for treatment failure due to antivenom resistance or lack of coverage for certain venomous snakes.
• Further research is required to identify the specific snake species and update antivenom formulations for improved patient outcomes.