Annals of Emergency Medicine
Volume 37, Issue 2 , Pages 196-201 , February 2001

Recurrence phenomena after immunoglobulin therapy for snake envenomations: part 2. Guidelines for clinical management with crotaline fab antivenom

Presented at the North American Congress of Clinical Toxicology’s “Advances in the Management of Snakebite” Symposium, October 1999, La Jolla, CA.

  • Leslie V. Boyer, MD

      Affiliations

    • Department of Pediatrics
    • Department of Pediatrics
    • Arizona Poison and Drug Information Center
    • ,
  • Steven A. Seifert, MD

      Affiliations

    • Arizona Poison and Drug Information Center
    • ,
  • Jeffrey S. Cain, MD

      Affiliations

    • University of Arizona Health Sciences Center, Tucson, AZ; and Darnall Army Community Hospital, Ft. Hood, TX.

Received 20 October 1999 ,Revised 1 November 2000 ,Accepted 1 December 2000.

References 

  1. Furlow TG, Brennan LV. Purpura following timber rattlesnake (Crotalus horridus horridus) envenomation. Cutis. 1985;35:234–236
  2. Budzynski AZ, Pandya BV, Rubin RN, et al.  Fibrinogenolytic afibrinogenemia after envenomation by Western diamondback rattlesnake (Crotalus atrox). Blood. 1984;63:1–14
  3. La Grange E, Russell FE. Blood platelet studies in man and rabbits following Crotalus envenomation. Proc West Pharmacol Soc. 1970;13:99–105
  4. Seifert SA, Boyer LV, Dart RC, et al.  Relationship of venom effects to venom antigen and antivenom serum concentrations in a patient with Crotalus atrox envenomation treated with a Fab antivenom. Ann Emerg Med. 1997;30:49–53
  5. Boyer LV, Seifert SA, Clark RF, et al.  Recurrent and persistent coagulopathy following pit viper envenomation. Arch Intern Med. 1999;159:706–710
  6. Meyer WP, Habib AG, Onayade AA, et al.  First clinical experiences with a new ovine Fab Echis ocellatus snake bite antivenom in Nigeria: randomized comparative trial with Institute Pasteur serum (IPSER) Africa antivenom. Am J Trop Med Hyg. 1997;56:291–300
  7. Seifert SA, Dart RC, Bogdan GM, et al.  Recurrence of local symptoms of crotalid envenomation in ovine Fab antivenom treated patients [abstract]. J Toxicol Clin Toxicol. 1999;37:390
  8. Seifert SA, Dart RC, Boyer LV, et al.  Prevention and treatment of recurrent local symptoms in crotalid envenomation treated with ovine Fab [abstract]. J Toxicol Clin Toxicol. 1999;37:668
  9. Hardy DL, Jeter M, Corrigan JJ. Envenomation by the Northern blacktail rattlesnake (Crotalus molossus molossus): report of two cases and the in vitro effects of the venom on fibrinolysis and platelet aggregation. Toxicon. 1982;20:487–493
  10. Bogdan GM, Dart RC, Falbo SC, et al.  Recurrent coagulopathy after antivenom treatment of Crotalid snakebite. South Med J. 2000;93:562–566
  11. Gillissen A, Theakston DG, Barth J, et al.  Neurotoxicity, haemostatic disturbances and haemolytic anaemia after a bite by a Tunisian saw-scaled viper (Echis ‘pyramidum’ -complex): failure of antivenom treatment. Toxicon. 1994;32:937–944
  12. Ho M, Warrell DA, Looareesuwan S, et al.  Clinical significance of venom antigen levels in patients envenomed by the Malayan pit viper (Calloselasma rhodostoma). Am J Trop Med Hyg. 1986;35:579–587
  13. Ho M, Warrell MJ, Warrell DA, et al.  A critical reappraisal of the use of enzyme-linked immunosorbent assays in the study of snakebite. Toxicon. 1986;24:211–221
  14. Theakston RDG, Phillips RE, Warrell DA, et al.  Envenoming by the common krait (Bungarus caeruleus) and Sri Lankan cobra (Naja naja naja): efficacy and complications of therapy with Haffkine antivenom. Trans Royal Soc Trop Med Hyg. 1990;34:301–308
  15. Karlson-Stiber C, Persson H. Antivenom treatment in Vipera berus envenoming—report of 30 cases. J Intern Med. 1994;235:57–61
  16. Ho M, Silamut K, White N, et al.  Pharmacokinetics of three commercial antivenoms in patients envenomed by the Malayan pit viper, Calloselasma rhodostoma, in Thailand. Am J Trop Med Hyg. 1990;42:260–266
  17. Dart RC, Seifert SA, Carroll L, et al.  Affinity-purified, mixed monospecific Crotalid antivenom ovine Fab for the treatment of Crotalid venom poisoning. Ann Emerg Med. 1997;30:33–39
  18. Russell FE. In: Snake Venom Poisoning. 2nd ed. Great Neck, NY: : Scholium; 1983;p. 186–209 280-314
  19. Burch JM, Agarwal R, Mattox KL, et al.  The treatment of crotalid envenomation without Antivenin. J Trauma. 1988;28:35–43
  20. Curry SC, Kunkel DB. Death from a rattlesnake bite. Am J Emerg Med. 1985;3:227–235
  21. Kitchens CS, Van Mierop LHS. Mechanism of defibrination in humans after envenomation by the eastern diamondback rattlesnake. Am J Hematol. 1983;14:345–353
  22. Van Mierop LHS. Poisonous snakebite: a review. 1. Snakes and their venom. J Fla Med Assoc. 1976;63:191–199
  23. Reid HA. Defibrination by Agkistrodon rhodostoma venom. In:  Russell FE editors. Animal Toxins. New York, NY: : Pergamon Press; 1967;
  24. Kitchens CS. Hemostatic aspects of envenomation by North American snakes. Hematol Oncol Clin North Am. 1992;6:1189–1195
  25. Gaydos , Freireich , Mantel . The quantitative relation between platelet count and hemorrhage in patients with acute leukemia. N Engl J Med. 1962;18:905–909
  26. Dutcher JP, Schiffer CA, Aisner J, et al.  Incidence of thrombocytopenia and serious hemorrhage among patients with solid tumors. Cancer. 1984;53:557–562
  27. Al-Mondhiry E. Congenital afibrinogenemia. Am J Hematol. 1994;46:343–347
  28. Mammen EF. Fibrinogen abnormalities. Semin Thromb Hemost. 1983;9:1–9
  29. Roberts , Bingham . Other coagulation factor deficiencies. In:  Loscalzo J,  Schafer AI editor. Thrombosis and Hemorrhage. 2nd ed. Baltimore, MD: : Williams & Wilkins; 1998;p. 773–803
  30. Launbjerg J, Egeblad H, Heaf J, et al.  Bleeding complications to oral anticoagulant therapy: multivariate analysis of 1010 treatment years in 551 outpatients. J Intern Med. 1991;229:351–355
  31. Landefeld CS, Goldman L. Major bleeding in outpatients treated with warfarin: incidence and prediction by factors known at the start of outpatient therapy. Am J Med. 1989;87:144–152
  32. Levine MN, Raskob G, Landefeld S, et al.  Hemorrhagic complications of anticoagulant treatment. Chest. 1995;108(4 Suppl):276s–290s
  33. Kapsch DN, Adelstein EH, Rhodes GR, et al.  Heparin-induced thrombocytopenia, thrombosis, and hemorrhage. Surgery. 1979;86:148–155
  34. Cohen M, Demers C, Gurfinkey EP, et al.  A comparison of low molecular weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med. 1997;337:447–452
  35. In:  Goldfrank LR,  Flomenbaum NE,  Lewin NA, et al. editor. Goldfrank’s Toxicologic Emergencies. 6th ed. New York, NY: : Appleton & Lange; 1998;

☆ Supported in part by Altana, Inc.

☆☆ Address for reprints: Leslie Boyer, MD, Arizona Poison and Drug Information Center, 1501 North Campbell Avenue, Tucson, AZ 85724; 520-626-6229, fax 520-626-2720;,E-mail boyer@pharmacy.arizona.edu .

PII: S0196-0644(01)75897-0

doi: 10.1067/mem.2001.113134

Annals of Emergency Medicine
Volume 37, Issue 2 , Pages 196-201 , February 2001

Article Tools

* Image Usage & Resolution