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.