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Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013-2017.
Clin Toxicol (Phila). 2020 03; 58(3):178-182.CT

Abstract

Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium's (ToxIC) North American Snakebite Registry (NASBR)

Methods:

Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management.

Results:

Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7-12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours.Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations.

Conclusions:

Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours.

Authors+Show Affiliations

Reno School of Medicine, University of Nevada, Reno, NV, USA.Southwestern Medical Center, University of Texas, Dallas, TX, USA.Baylor College of Medicine, Houston, TX, USA.Banner Good Samaritan Medical Center, Phoenix, AZ, USA.Emergency Medicine, Medical Toxicology, University of Colorado, Denver, CO, USA.Southwestern Medical Center, University of Texas, Dallas, TX, USA.American College of Medical Toxicology, Phoenix, AZ, USA.Emergency Medicine, Medical Toxicology, University of Colorado, Denver, CO, USA.Southwestern Medical Center, University of Texas, Dallas, TX, USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31190571

Citation

Domanski, K, et al. "Cottonmouth Snake Bites Reported to the ToxIC North American Snakebite Registry 2013-2017." Clinical Toxicology (Philadelphia, Pa.), vol. 58, no. 3, 2020, pp. 178-182.
Domanski K, Kleinschmidt KC, Greene S, et al. Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013-2017. Clin Toxicol (Phila). 2020;58(3):178-182.
Domanski, K., Kleinschmidt, K. C., Greene, S., Ruha, A. M., Bebarta, V. S., Onisko, N., Campleman, S., Brent, J., & Wax, P. (2020). Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013-2017. Clinical Toxicology (Philadelphia, Pa.), 58(3), 178-182. https://doi.org/10.1080/15563650.2019.1627367
Domanski K, et al. Cottonmouth Snake Bites Reported to the ToxIC North American Snakebite Registry 2013-2017. Clin Toxicol (Phila). 2020;58(3):178-182. PubMed PMID: 31190571.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cottonmouth snake bites reported to the ToxIC North American snakebite registry 2013-2017. AU - Domanski,K, AU - Kleinschmidt,K C, AU - Greene,S, AU - Ruha,A M, AU - Bebarta,V S, AU - Onisko,N, AU - Campleman,S, AU - Brent,J, AU - Wax,P, AU - ,, Y1 - 2019/06/13/ PY - 2019/6/14/pubmed PY - 2019/6/14/medline PY - 2019/6/14/entrez KW - Toxinology KW - antivenins KW - complications of poisoning KW - organ/tissue specific KW - skin KW - snakes KW - toxinology SP - 178 EP - 182 JF - Clinical toxicology (Philadelphia, Pa.) JO - Clin Toxicol (Phila) VL - 58 IS - 3 N2 - Introduction: The majority of venomous snake exposures in the United States are due to snakes from the subfamily Crotalinae (pit vipers). There are three types of US pit vipers: rattlesnakes (Crotalus and Sisturus spp.) copperheads (Agkistrodon contortrix), and cottonmouths (Agkistrodon piscivorus) also known as water moccasins. Cottonmouth bites are reported less frequently than other pit viper envenomations, and data on cottonmouth envenomation are limited. Our objective was to describe the epidemiology, clinical manifestations, and management of cottonmouth envenomations using prospective data reported to the Toxicology Investigators Consortium's (ToxIC) North American Snakebite Registry (NASBR)Methods: Cottonmouth envenomation cases reported to NASBR for the period from January 1, 2013, through December 31, 2017 were reviewed. Variables collected included patient demographics, bite location, clinical manifestations, and management.Results: Thirty-one cottonmouth envenomations were reported. Most bites occurred in children aged 7-12 (39%). Most bites involved the lower extremity (72%). Intentional interaction with the snake occurred in three cases (10%). Swelling was the most reported clinical effect and occurred in all patients. Gastrointestinal symptoms were reported in 19% of patients, and 19% developed coagulopathy. Antivenom treatment was used in 84% of patients. Nineteen patients (61%) required hospital stays of >24 hours.Discussion: Our study represents the first systematic prospective data collection on cottonmouth bites. Our data demonstrate that cottonmouth envenomations cause primarily local effects and, occasionally, systemic toxicity. Our study also demonstrates that antivenom is often indicated for these envenomations per published guidelines and recommendations.Conclusions: Cottonmouth envenomations are relatively infrequent. However, they can cause significant local and systemic toxicity. Most cottonmouth envenomations in this series were treated with antivenom and were hospitalized beyond 24 hours. SN - 1556-9519 UR - https://www.unboundmedicine.com/medline/citation/31190571/Cottonmouth_snake_bites_reported_to_the_ToxIC_North_American_snakebite_registry_2013-2017 L2 - http://www.tandfonline.com/doi/full/10.1080/15563650.2019.1627367 DB - PRIME DP - Unbound Medicine ER -
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