Introduction
Snakebite envenomation is a common medical emergency in several regions
of the United States. North central Florida is home to several
indigenous pit vipers including the eastern diamondback rattlesnake
(Crotalus adamanteus ), the water moccasin (Agkistrodon
piscivorus ), timber rattlesnake (Crotalus horridus ), and the
pygmy rattlesnake (Sistrurus miliarius ).1 Most
of the canine veterinary literature describes snakebite envenomation
adults, excluding its effect or outcome on pediatrics.
Many dogs free roam leading to several unwitnessed bites. Therefore, the
attending clinician often needs to make the diagnosis based on physical
examination and supporting characteristic effects of envenomation
including coagulopathy, hemolysis, neurological signs, hypotension,
pain, and soft tissue damage. Clinical signs vary according to the snake
involved, amount of venom delivered, venom components in the particular
snake, and previous comorbidities of the victim. Except for the pygmy
rattlesnake that causes severe pain at the bite site and occasional
thrombocytopenia, the remaining pit vipers have venom causing various
combinations of hemolysis, vasculotoxicity, tissue toxicity,
coagulopathy, and rhabdomyolysis. Cardiotoxicity and neurotoxicity are
additional features of eastern diamondback rattlesnake venom while some
timber rattlesnakes have potent neurotoxicity.2
Limited evidence-based data exists to guide medical management of pit
viper envenomation in children, and no pediatric guidelines exist in
veterinary medicine. Pit viper envenomation in children was historically
accompanied by an increased concern for grave consequences due to
smaller patient size, thus theoretically exposing the victim to a higher
concentration of venom per kilogram and potentially more severe
consequences from the venom compared to adults.3Recent literature in human medicine advocates for judicious use of
antivenom based on systemic involvement (coagulopathy, shock,
neurological signs, gastrointestinal signs, etc.) with infrequent
fasciotomies reserved for management of compartment
syndrome.4,5 Although variable, antivenom protocols in
children recommend initial control of systemic signs with 4 to 18 (mean
7.7) vials of F(ab) antivenom with subsequent maintenance therapy of 2
vials every 6 hours.6 Hospitalization ranges from one
to eight days (average 2 days), use of empirical antimicrobial therapy
is discouraged, and outcome is often favorable.5,7,8
The objectives of this case series are to describe pit viper
envenomation in five pediatric dogs, which has not been previously
reported, and to show that treatment conforms to standard treatment
recommended for mature dogs.