title: Poisonous snakebite in central Texas. Possible indicators for antivenin treatment.
abstract: Sixty-seven patients hospitalized for poisonous snakebite between 1975 and 1990 were managed by elevation, tetanus prophylaxis, intravenous fluids and antibiotics, and often by a limited excision of the bite site in the Emergency Department, with sequential laboratory studies as needed. Antivenin was used for systemic envenomation, and 23 of the 67 patients (34%) received 133 vials. Thirteen of the twenty-three patients (56%) had adverse reactions to the antivenin. Two significant observations arose. First age was an indicator. Eleven of eighteen patients 12 years or younger (61%) received antivenin, whereas 12 of 49 patients older than 12 years (24%) received antivenin (p = 0.0085, Fisher's exact test). Second species of snake was an indicator. Sixty-two snakes were identified (93%). Of 39 rattlesnake (Crotalus and Sistrurus) bites, 20 patients received antivenin (53%), but of 23 copperhead and water moccasin (Agkistrodon) bites, only three patients (12.5%) received antivenin (p = 0.0025). Antivenin may be indicated for use in systemic rattlesnake envenomation, especially in younger patients.
authors.affiliation: Department of Surgery, Texas A&M University College of Medicine, Scott and White Clinic and Hospital, Temple, Texas.
authors.forename: R R
authors.initials: RR
authors.lastname: White
authors.forename: R A
authors.initials: RA
authors.lastname: Weber
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000997:Antivenins / Q000009:adverse effects / Q000627:therapeutic use*; D001772:Blood Cell Count; D001780:Blood Coagulation Tests; D002648:Child; D002675:Child, Preschool; D003435:Crotalid Venoms; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011998:Recreation; D012909:Snake Bites / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D013781:Texas
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms