Envenomation: a Report of Three Cases

Background: envenomation is associated with severe hematological and wound complications but is rarely described.

Case Presentation: Herein, we report three cases of victims bitten by and indicate that rapid-onset severe coagulopathy and thrombocytopenia are distinct features of snakebite, which are not observed in other crotaline snakebites (i.e., and ) in Taiwan. The toxic effects could occur as early as 2 to 3 h following envenomation and persist if the administration of specific antivenom is delayed or even not commenced. Based on our findings, 2 to 4 vials of specific antivenom as the first dose should be administered to victims and repeated at 6 to 8 h intervals if coagulopathy or thrombocytopenia persists. Fresh frozen plasma or platelet replacement is probably safe as an adjunct therapy for bite in the presence of venom-induced consumptive coagulopathy.

Conclusion: Severe coagulopathy and thrombocytopenia could occur as early as 2 to 3 h after envenomation. The current recommendation for antivenom is 2 to 4 vials as the first dose and repeated every 6- to 8 h if coagulopathy or thrombocytopenia persists. These cases studied may be helpful to first-line medical personnel in the early diagnosis and management of envenomation among other crotaline snakebites in Taiwan.