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Published on: October 6, 2023
Elevated compartment pressures from copperhead envenomation successfully treated with antivenin
Maryann Mazer-Amirshahi1, Amy Boutsikaris2, Cathleen Clancy3
1National Capital Poison Center, Washington, DC; Children's National Medical Center, Washington, DC; The George Washington University, Washington, DC.
The Journal of Emergency Medicine
|July 23, 2013
Summary
Early antivenin treatment for copperhead bites may prevent compartment syndrome. Aggressive Crotalidae polyvalent immune Fab administration in a pediatric case successfully managed elevated compartment pressures, avoiding fasciotomy.
Area of Science:
- Toxicology
- Emergency Medicine
- Pediatric Care
Background:
- Copperhead envenomation typically causes local tissue damage.
- Compartment syndrome is a rare but serious complication of copperhead bites.
Observation:
- A 17-month-old child presented with severe foot and ankle swelling after a copperhead bite.
- Despite initial antivenin, compartment pressures remained critically high (85 mm Hg anteriorly).
- Fasciotomy was deferred due to maintained pulses and sensation.
Findings:
- Aggressive administration of Crotalidae polyvalent immune Fab (26 vials total) led to improved compartment pressures and reduced limb swelling.
- The patient avoided surgical intervention (fasciotomy) and experienced improved limb function.
- No significant coagulopathy or thrombocytopenia developed.
Implications:
- Early and high-dose antivenin therapy can be effective in managing severe copperhead envenomation with elevated compartment pressures.
- This approach may prevent the need for invasive procedures like fasciotomy.
- Highlights the importance of considering aggressive antivenin use in pediatric cases of venomous snakebites.
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