Rattlesnake venoms can cause a wide range of adverse human health effects. However, with the availability of modern antivenin, toxicity can generally be minimized and controlled. We present a rare case of rattlesnake envenomation resulting in severe systemic effects and syndrome relapse. Management considerations and patient course are described in the context of the current literature.
GoldBSDartRCBarishRA. Bites of venomous snakes. N Engl J Med. 2002;347(5):347–356.
2.
GermanBTHackJBBrewerKMeggsWJ. Pressure-immobilization bandages delay toxicity in a porcine model of eastern coral snake (Micrurus fulvius fulvius) envenomation. Ann Emerg Med. 2005;45(6):603–608.
3.
MeggsWJCourtneyCO'RourkeDBrewerKL. Pilot studies of pressure-immobilization bandages for rattlesnake envenomations. Clin Toxicol (Phila). 2010;48(1):61–63.
4.
BushSPGreenSMLaackTAHayesWKCardwellMDTanenDA. Pressure immobilization delays mortality and increases intracompartmental pressure after artificial intramuscular rattlesnake envenomation in a porcine model. Ann Emerg Med. 2004;44(6):599–604.
5.
HackJBOrogbemiBDeguzmanJMBrewerKLMeggsWJO'RourkeD. A localizing circumferential compression device delayed death after artificial eastern diamondback rattlesnake envenomation to the torso of an animal model in a pilot study. J Med Toxicol. 2010;6(2):207–211.
6.
JanesDNJrBushSPKolluruGR. Large snake size suggests increased snakebite severity in patients bitten by rattlesnakes in Southern California. Wilderness Environ Med. 2010;21(2):120–126.
7.
GoldBSBarishRA. Venomous snakebites. Current concepts in diagnosis, treatment, and management. Emerg Med Clin North Am. 1992;10(2):249–267.
8.
YinSKokkoJLavonasEMlynarchekSBogdanGSchaefferT. Factors associated with difficulty achieving initial control with crotalidae polyvalent immune fab antivenom in snakebite patients. Acad Emerg Med. 2011;18(1):46–52.
9.
KitchensCSVan MieropLH: Envenomation by the eastern coral snake (Micrurus fulvius fulvius): a study of 39 victims. JAMA. 1987;258(12):1615–1618.
HinzeJDBarkerJAJonesTRWinnRE. Life-threatening upper airway edema caused by a distal rattlesnake bite. Ann Emerg Med. 2001;38(1):79–82.
12.
VohraRCantrellFLWilliamsSR. Fasciculations after rattlesnake envenomations: a retrospective statewide poison control system study. Clin Toxicol (Phila). 2008;46(2):117–121.
13.
HasibaURosenbachLMRockwellDLewisJH. DIC-like syndrome after envenomation by the snake, Crotalus horridus horridus. N Engl J Med. 1975;292(10):505–507.
14.
BronsteinACSpykerDACantilenaLRJrGreenJLRumackBHGiffinSL. 2008Annual Report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 26th Annual Report. Clin Toxicol (Phila). 2009 Dec;47(10):911–1084.
15.
Crotalidae Polyvalent Immune Fab (Ovine) [FDA package insert]. Brentwood, TN: Protherics US Inc.
16.
ConsroePEgenNBRussellFE. Comparison of a new ovine antigen binding fragment (Fab) antivenin for United States Crotalidae with the commercial antivenin for protection against venominduced lethality in mice. J Trop Med Hyg. 1995;53(5):507–510.
17.
AnzAWSchweppeMHalvorsonJBushnellBSternbergMAndrewKL. Management of venomous snakebite injury to the extremities. J Am Acad Orthop Surg. 2010;18(12):749–759.
18.
DartRCHurlbutKMGarciaRBorenJ. Validation of a severity score for the assessment of crotalid snakebite. Ann Emerg Med. 1996;27(3):321–326.
19.
CrockerPZadOMillingTMaxsonTKingBWhortonE. Human cytokine response to Texas crotaline envenomation before and after antivenom administration. Am J Emerg Med. 2010;28(8):871–879.
FelicoriLFSouzaCTVelardeDT. Kallikrein-like proteinase from bushmaster snake venom. Protein Expr Purif. 2003;30(1):32–42.
22.
JoubertFJMerrifieldEH. Properties of the arginine esterases from Bitis nasicornis (horned adder) venom. Hoppe Seylers Z Physiol Chem. 1984;365(10):1219–1225.
23.
AlagonAPossaniLDSmartJSchleuningWD. Helodermatine, a kallikrein-like, hypotensive enzyme from the venom of Heloderma horridum horridum (Mexican beaded lizard). J Exp Med. 1986;164(6):1835–1845.
24.
MarklandFS. Snake venoms and the hemostatic system. Toxicon. 1998;36(12):1749–1800.
25.
ChiouSHHungCCLinCW. Isolation of a crotalase-like protease with alpha-fibrinogenase activity from the western diamondback rattlesnake, Crotalus atrox. Biochem Int. 1992;26(1):105–112.
26.
BoyerLVSeifertSAClarkRF. Recurrent and persistent coagulopathy following pit viper envenomation. Arch Intern Med. 1999;159(7):706–710.
27.
CamilleriCOffermanSGosselinRAlbertsonT. Conservative management of delayed, multicomponent coagulopathy following rattlesnake envenomation. Clin Toxicol (Phila). 2005;43(3):201–206.
28.
BogdanGMDartRCFalboSCMcNallyJSpaiteD. Recurrent coagulopathy after antivenom treatment of crotalid snakebite. South Med J. 2000;93(6):562–566.
29.
RuhaAMCurrySCAlbrechtCRileyBPizonA. Late hematologic toxicity following treatment of rattlesnake envenomation with crotalidae polyvalent immune Fab antivenom. Toxicon. 2011;57(1):53–59.
30.
O'BrienNFDeMottMCSuchardJRClarkRFPetersonBM. Recurrent coagulopathy with delayed significant bleeding after crotaline envenomation. Pediatr Emerg Care. 2009;25(7):457–459.
31.
HerbertSSHayesWK. Denim clothing reduces venom expenditure by rattlesnakes striking defensively at model human limbs. Ann Emerg Med. 2009;54(6):830–836.