Snake Envenomation

Adesola Odunayo, DVM, MS, DACVECC, University of Tennessee

Emergency Medicine & Critical Care

|May 2019|Peer Reviewed

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ANTIVENOM RECOMMENDATIONS

Clinicians should start with one vial of antivenom per patient; however, patients with a lower body weight may require more antivenom,^1-5as smaller patients tend to receive a larger amount of venom per kg of body weight when bitten (eg, a Chihuahua vs a Great Dane injected with the same amount of venom).⁵
If the antivenom is lyophilized, one vial should be reconstituted with crystalloid fluids (100-250 mL).⁵
Antivenom should be administered intravenously over 1 to 2 hours.^2,3
Patients should be monitored for signs of anaphylactoid/anaphylactic reactions.
Diphenhydramine may be considered if anaphylaxis or a mild anaphylactoid reaction to the antivenom is suspected, whereas epinephrine and intravenous fluids should be administered for severe anaphylaxis/anaphylactoid reactions.² Administration of antivenom should be stopped in both instances.⁴ However, if the reaction is not severe, administration of antivenom should be slowly resumed after approximately 20 to 60 minutes.⁴ Additional support in patients with hypotension (eg, vasopressors) and/or respiratory signs (eg, mechanical ventilation) may be required.¹

*Coral snakes and pit vipers (eg, rattlesnakes, copperheads, water moccasins, cottonmouths) are among the venomous snakes found in the United States.^2,4

ALP = alkaline phosphatase, ALT = alanine transaminase, AST = aspartate aminotransferase, GGT = gamma-glutamyl transferase, PCV = packed cell volume, TS = total solids

References

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Armentano RA, Schaer M. Overview and controversies in the medical management of pit viper envenomation in the dog. J Vet Emerg Crit Care (San Antonio). 2011;21(5):461-470.
McCown JL, Cooke KL, Hanel RM, Jones GL, Hill RC. Effect of antivenin dose on outcome from crotalid envenomation: 218 dogs (1988-2006). J Vet Emerg Crit Care (San Antonio). 2009;19(6):603-610.
Gilliam LL, Brunker J. North American snake envenomation in the dog and cat. Vet Clin North Am Small Anim Pract. 2011;41(6):1239-1259.
Wells RJ, Hopper K. Management of clinical snake bite in dogs and cats. In: Gopalakrishnakone P, Vogel CW, Seifert SA, Tambourgi DV, eds. Clinical Toxinology in Australia, Europe, and Americas. Springer; 2018:487-503.
Goddard A, Schoeman JP, Leisewitz AL, Nagel SS, Aroch I. Clinicopathologic abnormalities associated with snake envenomation in domestic animals. Vet Clin Pathol. 2011;40(3):282-292.
Stanley MK. Viscoelastic Coagulation Changes in Dogs with Tiger Snake Envenomation [master’s thesis]. Melbourne: University of Melbourne; 2018.
Lieblick BA, Bergman PJ, Peterson NW. Thromboelastographic evaluation of dogs bitten by rattlesnakes native to southern California. Am J Vet Res. 2018;79(5):532-537.
Carr A, Schultz J. Prospective evaluation of the incidence of wound infection in rattlesnake envenomation in dogs. J Vet Emerg Crit Care (San Antonio). 2015;25(4):546-551.
Hoose JA, Carr A. Retrospective analysis of clinical findings and outcome of cats with suspected rattlesnake envenomation in southern California: 18 cases (2007-2010). J Vet Emerg Crit Care (San Antonio). 2013;23(3):314-320.
Witsil AJ, Wells RJ, Woods C, Rao S. 272 cases of rattlesnake envenomation in dogs: demographics and treatment including safety of F(ab’)2 antivenom use in 236 patients. Toxicon. 2015;105:19-26.
Pashmakova MB, Bishop MA, Black DM, et al. Multicenter evaluation of the administration of crotalid antivenom in cats: 115 cases (2000-2011). J Am Vet Med Assoc. 2013;243(4):520-525.
Birnie GL, Fry DR, Best MP. Safety and tolerability of hyperbaric oxygen therapy in cats and dogs. J Am Anim Hosp Assoc. 2018;54(4):188-194.
Korambayil PM, Ambookan PV, Abraham SV, Ambalakat A. A multidisciplinary approach with hyperbaric oxygen therapy improve outcome in snake bite injuries. Toxicol Int. 2015;22(1):104-109.
Odunayo A. Fluid therapy. Clinician’s Brief. 2018;16(10):71-75.

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Snake Envenomation

Adesola Odunayo, DVM, MS, DACVECC, University of Tennessee

Emergency Medicine & Critical Care

ANTIVENOM RECOMMENDATIONS

Suggested Reading

References

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