Case 1
A 14 week-old, 10.8 kg male intact American Pit Bull Terrier was evaluated for suspect pit viper envenomation. The puppy was unsupervised outside for two hours and found limping on his left hindlimb with two bleeding punctures over his fourth digit. Physical examination revealed left pelvic limb weight-bearing lameness with hemorrhagic lymphedema around two punctures on the left hind paw. The mentation and vitals were normal. A pain score* of 1/4 was assigned. Clinicopathologic abnormalities included: mild hyponatremia (140 mmol/L, reference range 146-151 mmol/L), mild hypochloremia (105 mmol/L, reference range 108.5-116 mmol/L), mild anemia [packed cell volume (PCV) 32%, reference range 33-55%] without hemolysis, and moderate hypoproteinemia [total solids (TS): 48 g/L (reference range 65-80 g/L); 4.8 g/dL (reference 6.5-8 g/dL]. The activated clotting time (ACT) was normal (96 seconds (s); reference range 80-120 s). A snakebite severity score (SSS)9 was 1/20. One vial of F(ab)2 antivenom§ was diluted in 60 mL 0.9% salineǁ and administered intravenously (IV) over an hour. Six hours later, the SSS was 2/20. The puppy was maintained on IV lactated Ringer’s solution (LRS) at 4 mL/kg/hr and methadone** (0.25mg/kg IV) if pain scores exceeded 1.5/4. No progression of envenomation or adverse reactions to antivenom occurred and the puppy was discharged 20 hours later.