Anuric Renal Failure, Pancreatitis, and Acute Respiratory Distress Syndrome in Bothrops venezuelensis Envenomation

• Main Authors: Hayes, A K, Mullins, ME, Keyler, DE, Halcomb, SE
• Format: Conference Proceeding
• Language: English
• Subjects: Bothrops
• ISSN: 1556-3650

Background: Bothrops envenomations cause significant morbidity and mortality resulting in more fatalities in the Americas than snakes of all other genera. Envenomation by the Venezuelan Lancehead, Bothrops venezuelensis, has rarely been reported, and this case is the first documented case in the US. Case Report: A 56 year-old male amateur herpetologist was bitten on the 3 super(rd) digit of his right hand by Bothrops venezuelensis. His history included 26 prior envenomations by various species of North, Central, and South American Crotalids and Colubrids, African vipers, and Asian pit vipers. Within minutes he injected 1 mL of polyvalent antivenom (Institute Clodomiro Picado-Polyspecific, Costa Rica) at the bite site. Eight hours later he had nausea, vomiting, abdominal pain and oliguria. At 24 hrs he presented to the ED, was afebrile, mildly hypertensive, and in no acute distress. The bite site was oozing serous fluid, with swelling and erythema extending to the elbow. Initial labs included creatinine 4.8 mg/dL, INR 3.26, D-dimer 6860 ng/mL, fibrinogen 122 mg/dL, PTT >150 sec, and platelets 69k/cu mm. CT showed evidence of acute pancreatitis. Initial ED treatment involved aggressive fluid resuscitation, cryoprecipitate, and administration of 5 vials of antivenom (Antivipmyn Polyvalent, Bioclon, Mexico). The patient was admitted to the ICU, the coagulopathy stabilized; however he was anuric with rising creatinine. On hospital day 2, he was intubated for acute respiratory distress syndrome, and remained intubated for 10 days. Pancreatitis resolved. The bite site was debrided of local necrotic tissue. Hyperkalemia prompted dialysis, but renal function did not recover. At discharge he was dialysis dependent. Case Discussion: Acute renal failure without hypoperfusion and without return of normal renal function suggests a direct nephrotoxic effect of Bothrops venezuelensis venom. Conclusion: This patient displayed complications of Bothrops venezuelensis envenomation including anuric renal failure, pancreatitis, thrombocytopenia, coagulopathy and ARDS.