Case 3
A 15 week-old, 9.1 kg female intact Golden Retriever puppy was examined within 30 minutes of suspected pit viper envenomation after being found outside with a left swollen muzzle and two puncture wounds two centimeters apart. Aside from moderate left-sided facial swelling, the physical examination was unremarkable. Vitals were normal and the pain score* was 0/4. Abnormal clinicopathologic parameters included mild hypoproteinemia [TS 50 g/L (5 g/dL), reference range 65-80 g/L 6.5-8 g/dL)] with slight hemolysis and hypocoagulability (ACT >999s; reference range 80-120s). The SSS was 6/20 and one vial of diluted F(ab)2 antivenom§was administered IV over four hours, followed by IV LRS at 3 mL/kg/hr. Six hours post-presentation, the ACT remained too high to read and the SSS was 6/20. A second vial of diluted F(ab)2 antivenom§ was administered IV over four hours. The puppy was hospitalized overnight where coagulopathy resolved and clinical improvement occurred with lower SSS values of 2/20 and 1/20 at 13 hours and 25 hours after admission, respectively. By day two, the puppy was clinically stable and discharged.