title: Envenoming byViridovipera stejnegerisnake: a patient with liver cirrhosis presenting disruption of hemostatic balance.
abstract: BACKGROUND
  In most cases of envenoming by the green habuViridovipera stejnegeriin Taiwan coagulopathy is not observed.
  
  
  METHODS
  Herein, we describe the case of a patient with liver cirrhosis who developed venom-induced consumptive coagulopathy afterV. stejnegeribite. Laboratory investigation revealed the following: prothrombin time > 100 s (international normalized ratio > 10), activated partial thromboplastin time > 100 s, fibrinogen < 50 mg/dL, and fibrin degradation product > 80 μg/mL. The patient recovered after administration of bivalent hemorrhagic antivenom, vitamin K, fresh frozen plasma and cryoprecipitate.
  
  
  CONCLUSIONS
  The liver, directly involved in the acute phase reaction, is the main responsible for neutralization of animal toxins. Any patient with history of liver cirrhosis bitten by a venomous snake, even those whose venoms present low risk of coagulopathy, should be very carefully monitored for venom-induced consumptive coagulopathy (VICC), since the hemostatic balance may be disrupted.
authors.affiliation: Department of General Surgery, Chang-Gung Memorial Hospital, Keelung Branch, 222, Maijin Road, Keelung, Taiwan.
authors.forename: Chih-Ying
authors.initials: CY
authors.lastname: Chien
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
authors.forename: Shu-Chen
authors.initials: SC
authors.lastname: Liao
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.affiliation: Department of General Surgery, Chang-Gung Memorial Hospital, Keelung Branch, 222, Maijin Road, Keelung, Taiwan.
authors.forename: Ting-Shuo
authors.initials: TS
authors.lastname: Huang
authors.affiliation: Department of General Surgery, Chang-Gung Memorial Hospital, Keelung Branch, 222, Maijin Road, Keelung, Taiwan.
authors.forename: Yu-Hsien
authors.initials: YH
authors.lastname: Chen
keywords: Coagulopathy; Liver cirrhosis; Snakebite