title: Complete clinical course of envenomation by Protobothrops mangshanensis: delayed coagulopathy and response to Trimeresurus albolabris antivenom.
abstract: BACKGROUND
  Protobothrops mangshanensis, the Mangshan pit viper, is a rare pit viper native to the area surrounding Mount Mang in China's Hunan province. Toxicity from envenomation is not well characterized.
  
  
  METHODS
  A 33-year-old male presented to an emergency department (ED) after being bitten on the forearm by his P. mangshanensis. He complained of mild swelling and pain at the bite site. He was admitted for observation and toxicology consultation. Following initially normal coagulation studies including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer, fibrinogen decreased to 121 mg/dL and D-dimer concurrently rose to 377 ng/mL over 24 h. On hospital day 2 fibrinogen stabilized at 109 mg/dL and he was discharged with outpatient laboratory monitoring. Three days later, he returned with bruising to the contralateral arm. Fibrinogen was undetectable (<40 mg/dL) and PT was 14.6 s. He declined admission but returned 2 d later with bruising to the nose. Bloodwork revealed immeasurably prolonged PT, aPTT, and thrombin time, but he eloped. Late that evening he returned and was treated with three vials of Green pit viper (Trimeresurus albolabris) antivenom. Within 24 h coagulopathy improved markedly; at five days, coagulation abnormalities resolved.
  
  
  CONCLUSIONS
  Mangshan pit viper envenomations may cause isolated hemotoxicity, despite molecular studies suggesting additional neurotoxicity and myotoxicity. T. albolabris antivenom appears effective in treating the resultant coagulopathy.
  
  
  CONCLUSIONS
  We report the natural history of envenomation by the Mangshan pit viper. A delayed coagulopathy, apparently fibrinolytic in nature, is unaccompanied by local tissue destruction and responsive to Green pit viper antivenom.
authors.affiliation: a Regions Toxicology Education & Clinical Service , St. Paul , MN , USA ;|b Minnesota Poison Control System , Minneapolis , MN , USA ;
authors.forename: Travis D
authors.initials: TD
authors.lastname: Olives
authors.affiliation: b Minnesota Poison Control System , Minneapolis , MN , USA ;
authors.forename: Jill M
authors.initials: JM
authors.lastname: Topeff
authors.affiliation: b Minnesota Poison Control System , Minneapolis , MN , USA ;
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Willhite
authors.affiliation: c Department of Pathology, Hennepin County Medical Center , Minneapolis , MN , USA ;
authors.forename: Virginia L
authors.initials: VL
authors.lastname: Kubic
authors.affiliation: d Department of Experimental and Clinical Pharmacology , University of Minnesota , Minneapolis , MN , USA ;
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Keyler
authors.affiliation: b Minnesota Poison Control System , Minneapolis , MN , USA ;|e Department of Emergency Medicine , Hennepin County Medical Center , Minneapolis , MN , USA.
authors.forename: Jon B
authors.initials: JB
authors.lastname: Cole
mesh_terms: D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D001778:Blood Coagulation Disorders / Q000097:blood / Q000188:drug therapy*; D001780:Blood Coagulation Tests; D018450:Disease Progression; D004487:Edema / Q000139:chemically induced / Q000188:drug therapy; D004632:Emergency Medical Services; D006801:Humans; D008297:Male; D010146:Pain / Q000139:chemically induced / Q000188:drug therapy; D012909:Snake Bites / Q000097:blood* / Q000188:drug therapy*; D016896:Treatment Outcome; D017841:Trimeresurus; D017819:Viperidae
chemical_list: D000997:Antivenins
keywords: Aconitine; Mangshan pit viper; Protobothrops; antivenins; snakes