One of the major manifestations of a Russell viper bite is a coagulopathy. Than et al classified the severity of the coagulopathy and the need for antivenom.
Mechanism: A phospholipase is present in the venom that activates Factor X in the coagulation cascade, resulting in defibrination and disseminated intravascular coagulopathy (DIC).
Group
Coagulation Abnormalities
Management
1
none (normal)
none
2
mild to moderate
Monitor. Most patients do not require therapy for coagulopathy.
3
severe to fulminant, may be evident within 1-2 hours after the bite
Antivenom and aggressive management.
Tests that can be monitor coagulation status:
(1) PT and aPTT
(2) Factor V and thrombin
(3) fibrinogen
(4) fibrin degradation products (FDP)
(5) platelet count
Serial monitoring of FDP levels during the first 12 hours after the bite can help to identify patients who have a serious envenomation and who may benefit from aggressive management.
To read more or access our algorithms and calculators, please log in or register.
