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Rattlesnake envenomation with neurotoxicity refractory to treatment with crotaline Fab antivenom.
Clin Toxicol (Phila). 2007 Jun-Aug; 45(5):472-5.CT

Abstract

INTRODUCTION

Neurotoxicity following rattlesnake envenomation is reported with certain crotaline species. In some instances, crotaline Fab antivenom therapy that effectively halts progression of local tissue edema and hemotoxicity fails to reverse neurologic venom effects.

CASE SERIES

A 50-year-old man presented following a rattlesnake envenomation to the left ring finger. He had swelling and pain in the affected hand and complained of dyspnea and dysphonia. Significant fasciculations were seen in the face, tongue, neck, trunk, and arms. The patient received crotaline Fab antivenom but continued to develop worsening respiratory distress. His respiratory insufficiency requiring ventilatory support appeared related to respiratory muscle incoordination as extremity motor function remained intact. Initial control of local edema progression and hematologic parameters was achieved with antivenom, but diffuse fasciculations involving the entire body worsened despite aggressive antivenom treatment. In another case, a 9-year-old boy was envenomated by a rattlesnake on the left thenar eminence. He presented with pain and swelling up to the forearm and fasciculations of the tongue, face, and upper extremities. The progression of edema was halted at the mid-bicep level and hematologic parameters normalized with crotaline Fab antivenom. However, fasciculations continued for two days despite antivenom treatment.

CONCLUSION

We describe two cases of neurotoxicity following rattlesnake envenomation in which treatment with crotaline Fab antivenom adequately obtained initial control of local swelling and hematologic effects, but neurotoxic venom effects remained refractory to antivenom therapy. This phenomenon is anecdotally recognized following certain crotaline species envenomations.

Authors+Show Affiliations

Palmetto Health Richland, Palmetto Poison Center, South Carolina College of Pharmacy-University of South Carolina, Columbia, South Carolina 29208, USA. whrichardson@sc.rr.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

17503249

Citation

Richardson, William H., et al. "Rattlesnake Envenomation With Neurotoxicity Refractory to Treatment With Crotaline Fab Antivenom." Clinical Toxicology (Philadelphia, Pa.), vol. 45, no. 5, 2007, pp. 472-5.
Richardson WH, Goto CS, Gutglass DJ, et al. Rattlesnake envenomation with neurotoxicity refractory to treatment with crotaline Fab antivenom. Clin Toxicol (Phila). 2007;45(5):472-5.
Richardson, W. H., Goto, C. S., Gutglass, D. J., Williams, S. R., & Clark, R. F. (2007). Rattlesnake envenomation with neurotoxicity refractory to treatment with crotaline Fab antivenom. Clinical Toxicology (Philadelphia, Pa.), 45(5), 472-5.
Richardson WH, et al. Rattlesnake Envenomation With Neurotoxicity Refractory to Treatment With Crotaline Fab Antivenom. Clin Toxicol (Phila). 2007 Jun-Aug;45(5):472-5. PubMed PMID: 17503249.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rattlesnake envenomation with neurotoxicity refractory to treatment with crotaline Fab antivenom. AU - Richardson,William H, AU - Goto,Collin S, AU - Gutglass,David J, AU - Williams,Saralyn R, AU - Clark,Richard F, PY - 2007/5/16/pubmed PY - 2007/7/31/medline PY - 2007/5/16/entrez SP - 472 EP - 5 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 45 IS - 5 N2 - INTRODUCTION: Neurotoxicity following rattlesnake envenomation is reported with certain crotaline species. In some instances, crotaline Fab antivenom therapy that effectively halts progression of local tissue edema and hemotoxicity fails to reverse neurologic venom effects. CASE SERIES: A 50-year-old man presented following a rattlesnake envenomation to the left ring finger. He had swelling and pain in the affected hand and complained of dyspnea and dysphonia. Significant fasciculations were seen in the face, tongue, neck, trunk, and arms. The patient received crotaline Fab antivenom but continued to develop worsening respiratory distress. His respiratory insufficiency requiring ventilatory support appeared related to respiratory muscle incoordination as extremity motor function remained intact. Initial control of local edema progression and hematologic parameters was achieved with antivenom, but diffuse fasciculations involving the entire body worsened despite aggressive antivenom treatment. In another case, a 9-year-old boy was envenomated by a rattlesnake on the left thenar eminence. He presented with pain and swelling up to the forearm and fasciculations of the tongue, face, and upper extremities. The progression of edema was halted at the mid-bicep level and hematologic parameters normalized with crotaline Fab antivenom. However, fasciculations continued for two days despite antivenom treatment. CONCLUSION: We describe two cases of neurotoxicity following rattlesnake envenomation in which treatment with crotaline Fab antivenom adequately obtained initial control of local swelling and hematologic effects, but neurotoxic venom effects remained refractory to antivenom therapy. This phenomenon is anecdotally recognized following certain crotaline species envenomations. SN - 1556-3650 UR - https://www.unboundmedicine.com/medline/citation/17503249/Rattlesnake_envenomation_with_neurotoxicity_refractory_to_treatment_with_crotaline_Fab_antivenom_ L2 - https://www.tandfonline.com/doi/full/10.1080/15563650701338187 DB - PRIME DP - Unbound Medicine ER -