Apparent Efficacy of Low-Dose Constant-Infusion Crotalidae Antivenom for Control of Defibrinogenation Recurrence Syndrome Following Envenomation by the Eastern Diamondback Rattlesnake (Crotalus adamanteus)
Methods: We analyzed all cases treated at the University of Florida between 2013 and 2014 for the rattlesnake bites. All cases were treated with Crotalidae Polyvalent Immune Fab as recommended per manufacturer recommendations upon initial presentation. However, upon the recurrence of defibrinogenation, we administered the antivenom 1 vial diluted in 250 ml of normal saline and administered by continuous IV infusion over 2 to 12 hours tapered over 2 to 3 days. The patients and their coagulation labs were monitored at least daily during the recurrence of the defibrinogenation.
Results: We identified 5 cases treated for Eastern Diamondback snake bites. All cases had recurrent defibrinogenation syndrome and treated as described above. All patients had normalization in their fibrinogen levels with the reinstitution of the antidote. Additionally, none of them had any further bleeding. No chills, fevers or cloudiness of solution reported during the continuous antidote administration.
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