title: Elevated compartment pressures from copperhead envenomation successfully treated with antivenin.
abstract: BACKGROUND
  Copperhead envenomation causes local soft tissue effects; however, associated compartment syndrome is rare. We report a case of a 17-month-old with significantly elevated compartment pressures successfully treated with antivenin and supportive care.
  
  
  METHODS
  A 17-month-old girl sustained a copperhead bite to the foot and presented with circumferential edema, erythema, and ecchymosis of the foot and distal ankle. The patient had palpable pulses and was neurologically intact. Four vials of Crotalidae polyvalent immune Fab was initiated and additional doses were administered in an attempt to achieve local control. Within 10 h of presentation, the patient's edema extended to the groin, although sensation was maintained and pulses were documented by Doppler. Lower-extremity compartment pressures were measured and were most notable for an anterior pressure of 85 mm Hg, despite having received 12 vials of antivenin. Fasciotomy was deferred and the patient received two additional six-vial doses of antivenin to achieve local control. Compartment pressures improved with a 2.2-cm mean decrease in limb diameter within 48 h. Maintenance dosing was initiated and the patient ultimately received a total of 26 vials of antivenin. The patient did not develop significant coagulopathy or thrombocytopenia. Swelling continued to improve with return of limb function.
  
  
  CONCLUSIONS
  In this case, early and aggressive treatment with antivenin may have avoided invasive fasciotomy, and its use should be considered in patients with copperhead envenomation and significantly elevated compartment pressures.
authors.affiliation: National Capital Poison Center, Washington, DC; Children's National Medical Center, Washington, DC; The George Washington University, Washington, DC.
authors.forename: Maryann
authors.initials: M
authors.lastname: Mazer-Amirshahi
authors.affiliation: INOVA Fairfax Hospital for Children, Fairfax, Virginia.
authors.forename: Amy
authors.initials: A
authors.lastname: Boutsikaris
authors.affiliation: National Capital Poison Center, Washington, DC; Children's National Medical Center, Washington, DC.
authors.forename: Cathleen
authors.initials: C
authors.lastname: Clancy
mesh_terms: D017836:Agkistrodon; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D003161:Compartment Syndromes / Q000209:etiology / Q000628:therapy*; D003435:Crotalid Venoms; D004487:Edema / Q000209:etiology; D005260:Female; D018409:Foot Injuries / Q000150:complications; D006801:Humans; D007155:Immunologic Factors / Q000627:therapeutic use*; D007223:Infant; D035002:Lower Extremity; D012909:Snake Bites / Q000150:complications / Q000628:therapy*
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms; D007155:Immunologic Factors
keywords: antivenin; compartment syndrome; copperhead envenomation