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Severe puff adder (Bitis arietans) envenomation with coagulopathy.
J Toxicol Clin Toxicol. 2002; 40(7):911-8.JT

Abstract

BACKGROUND

The puff adder (Bitis arietans) is a highly toxic venomous snake that is responsible for a large proportion of the venomous snakebites in sub-Saharan Africa, where it is indigenous. Puff adder bites in North America result from snakes in captivity. Although thrombolytic enzymes are present in puff adder venom, significant coagulopathy has not been previously reported with a confirmed puff adder envenomation.

RESULTS

We report a serious puff adder envenomation to the finger, characterized by severe swelling, local tissue necrosis, hypotension, thrombocytopenia, severe coagulopathy, and hemorrhage. Fifteen vials of South Africa polyvalent antivenom were administered, beginning 4.5 hours post-envenomation, with step-wise improvement in hematological abnormalities. Other treatments included vasopressors, ventilatory support, leeches, transfusion, and eventual digit amputation. After a prolonged hospital course, the patient had a good outcome.

CONCLUSIONS

Puff adder envenomation causes tissue necrosis, hypotension, coagulopathy, thrombocytopenia, and spontaneous bleeding. Severe coagulopathy may occur. Physicians treating severe cases should be prepared to administer at least 15 vials of antivenom if needed.

Authors+Show Affiliations

Division of Medical Toxicology, Department of Emergency Medicine & Carolinas Poison Center, Carolinas Medical Center, Charlotte, North Carolina 28209, USA. eric.lavonas@carolinashealthcare.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

12507061

Citation

Lavonas, Eric J., et al. "Severe Puff Adder (Bitis Arietans) Envenomation With Coagulopathy." Journal of Toxicology. Clinical Toxicology, vol. 40, no. 7, 2002, pp. 911-8.
Lavonas EJ, Tomaszewski CA, Ford MD, et al. Severe puff adder (Bitis arietans) envenomation with coagulopathy. J Toxicol Clin Toxicol. 2002;40(7):911-8.
Lavonas, E. J., Tomaszewski, C. A., Ford, M. D., Rouse, A. M., & Kerns, W. P. (2002). Severe puff adder (Bitis arietans) envenomation with coagulopathy. Journal of Toxicology. Clinical Toxicology, 40(7), 911-8.
Lavonas EJ, et al. Severe Puff Adder (Bitis Arietans) Envenomation With Coagulopathy. J Toxicol Clin Toxicol. 2002;40(7):911-8. PubMed PMID: 12507061.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe puff adder (Bitis arietans) envenomation with coagulopathy. AU - Lavonas,Eric J, AU - Tomaszewski,Christian A, AU - Ford,Marsha D, AU - Rouse,Anna M, AU - Kerns,William P,2nd PY - 2003/1/1/pubmed PY - 2003/1/15/medline PY - 2003/1/1/entrez SP - 911 EP - 8 JF - Journal of toxicology. Clinical toxicology JO - J Toxicol Clin Toxicol VL - 40 IS - 7 N2 - BACKGROUND: The puff adder (Bitis arietans) is a highly toxic venomous snake that is responsible for a large proportion of the venomous snakebites in sub-Saharan Africa, where it is indigenous. Puff adder bites in North America result from snakes in captivity. Although thrombolytic enzymes are present in puff adder venom, significant coagulopathy has not been previously reported with a confirmed puff adder envenomation. RESULTS: We report a serious puff adder envenomation to the finger, characterized by severe swelling, local tissue necrosis, hypotension, thrombocytopenia, severe coagulopathy, and hemorrhage. Fifteen vials of South Africa polyvalent antivenom were administered, beginning 4.5 hours post-envenomation, with step-wise improvement in hematological abnormalities. Other treatments included vasopressors, ventilatory support, leeches, transfusion, and eventual digit amputation. After a prolonged hospital course, the patient had a good outcome. CONCLUSIONS: Puff adder envenomation causes tissue necrosis, hypotension, coagulopathy, thrombocytopenia, and spontaneous bleeding. Severe coagulopathy may occur. Physicians treating severe cases should be prepared to administer at least 15 vials of antivenom if needed. SN - 0731-3810 UR - https://www.unboundmedicine.com/medline/citation/12507061/Severe_puff_adder__Bitis_arietans__envenomation_with_coagulopathy_ L2 - https://medlineplus.gov/bleedingdisorders.html DB - PRIME DP - Unbound Medicine ER -