title: Compartment syndrome after South American rattlesnake (Crotalus durissus terrificus) envenomation.
abstract: BACKGROUND
  In order to report the outcome of a patient who developed compartment syndrome after South American rattlesnake (Crotalus durissus terrificus) envenomation, confirmed by subfascial pressure measurement and magnetic resonance imaging (MRI).
  
  
  METHODS
  A 63-year-old male was admitted 1 h after being bitten on the right elbow by a "large" snake, which was not brought for identification. Physical and laboratory features upon admission revealed two fang marks, local tense swelling, paresthesia, intense local pain, hypertension, coagulopathy, and CK = 1530 U/L (RV < 170 U/L). The case was initially treated with bothropic antivenom (80 mL, intravenously), with no improvement. Evolution within 13-14 h post-bite revealed generalized myalgia, muscle weakness, palpebral ptosis, and severe rhabdomyolysis (CK = 126,160 U/L) compatible with envenoming by C. d. terrificus. The patient was then treated with crotalic antivenom (200 mL, intravenously), fluid replacement, and urine alkalinization. Twenty-four-hour post-bite MRI showed marked muscular edema in the anterior compartment of the right forearm, with a high subfascial pressure (40 mmHg) being detected 1 h later. ELISA of a blood sample obtained upon admission, before antivenom infusion, revealed a high serum concentration of C. d. terrificus venom. No fasciotomy was performed and the patient was discharged seven days later without sequelae.
  
  
  CONCLUSIONS
  Snakebite by C. d. terrificus with subfascial venom injection may lead to increased intracompartmental pressure.
authors.affiliation: Department of Pediatrics, Faculty of Medical Sciences, State University of Campinas (UNICAMP) , Campinas, SP , Brazil.
authors.forename: F
authors.initials: F
authors.lastname: Bucaretchi
authors.forename: E M
authors.initials: EM
authors.lastname: De Capitani
authors.forename: S
authors.initials: S
authors.lastname: Hyslop
authors.forename: S M
authors.initials: SM
authors.lastname: Mello
authors.forename: C B
authors.initials: CB
authors.lastname: Fernandes
authors.forename: F
authors.initials: F
authors.lastname: Bergo
authors.forename: F B P
authors.initials: FB
authors.lastname: Nascimento
mesh_terms: D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D003161:Compartment Syndromes / Q000175:diagnosis / Q000209:etiology*; D003435:Crotalid Venoms / Q000037:antagonists & inhibitors; D017839:Crotalus; D005542:Forearm / Q000098:blood supply; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012909:Snake Bites / Q000150:complications* / Q000188:drug therapy
chemical_list: D000997:Antivenins; D003435:Crotalid Venoms
keywords: Compartment syndrome; Crotalus durissus terrificus; ELISA; Magnetic resonance imaging; Snakebite