Deinagkistrodon acutusenvenomation: a report of three cases.
BACKGROUND
Deinagkistrodon acutusenvenomation is associated with severe hematological and wound complications but is rarely described.


METHODS
Herein, we report three cases of victims bitten byD. acutusand indicate that rapid-onset severe coagulopathy and thrombocytopenia are distinct features ofD. acutussnakebite, which are not observed in other crotaline snakebites (i.e.,Trimeresurus stejnegeriandProtobothrops mucrosquamatus) in Taiwan. The toxic effects could occur as early as 2 to 3 h followingD. acutusenvenomation and persist if the administration of specific antivenom is delayed or even not commenced. Based on our findings, 2 to 4 vials of specific antivenom as the first dose should be administered to victims and repeated at 6 to 8 h intervals if coagulopathy or thrombocytopenia persists. Fresh frozen plasma or platelet replacement is probably safe as an adjunct therapy forD. acutusbite in the presence of venom-induced consumptive coagulopathy.


CONCLUSIONS
Severe coagulopathy and thrombocytopenia could occur as early as 2 to 3 h afterD. acutusenvenomation. The current recommendation for antivenom is 2 to 4 vials as the first dose and repeated every 6- to 8 h if coagulopathy or thrombocytopenia persists. These cases studied may be helpful to first-line medical personnel in the early diagnosis and management ofD. acutusenvenomation among other crotaline snakebites in Taiwan.
Department of Emergency Medicine, Kaohsiung Armed Forces General Hospital, Taipei, Taiwan.|Department of Emergency Medicine, Division of Clinical Toxicology, Taichung Veterans General Hospital, Taipei, Taiwan.
Chin-Lung
CL
Cheng
Department of Emergency Medicine, Division of Clinical Toxicology, Taichung Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, Division of Clinical Toxicology and Occupational Medicine, Taipei Veterans General Hospital, 201 Sec. 2, Shipai Road., Taipei, 112 Taiwan.|Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Yan-Chiao
YC
Mao
Department of Medicine, Division of Infection, Taichung Veterans General Hospital, Taichung, Taiwan.
Po-Yu
PY
Liu
National Tsing Hua University, College of Life Sciences, Hsinchu, Taiwan.|National Health Research Institutes, National Institute of Infectious Diseases and Vaccinology, Zhunan, Miaoli Taiwan.
Liao-Chun
LC
Chiang
Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Department of Emergency Medicine, Chang Guang Memorial Hospital, Taipei, Taiwan.
Shu-Chen
SC
Liao
Department of Medicine, Division of Clinical Toxicology and Occupational Medicine, Taipei Veterans General Hospital, 201 Sec. 2, Shipai Road., Taipei, 112 Taiwan.|Institute of Environmental and Occupational Health Sciences, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Chen-Chang
CC
Yang
Coagulopathy; Deinagkistrodon acutus; Envenomation; Snakebite; Thrombocytopenia