Envenoming by Viridovipera stejnegeri snake: a patient with liver cirrhosis presenting disruption of hemostatic balance
Chih-Ying Chien1*, Shu-Chen Liao2 , Chien-Hung Liao3 , Ting-Shuo Huang1 and Yu-Hsien Chen1 [ + show more ]
Received: 27 September 2016 | Accepted: 19 January 2017 | Published: 14 February 2017
https://doi.org/10.1186/s40409-017-0096-9
Abstract
Background: In most cases of envenoming by the green habu Viridovipera stejnegeri in Taiwan coagulopathy is not observed. Case presentation: Herein, we describe the case of a patient with liver cirrhosis who developed venom-induced consumptive coagulopathy after V. stejnegeri bite. Laboratory investigation revealed the following: prothrombin time > 100 s (international normalized ratio > 10), activated partial thromboplastin time > 100 s, fibrinogen < 50 mg/ dL, and fibrin degradation product > 80 μg/mL. The patient recovered after administration of bivalent hemorrhagic antivenom, vitamin K, fresh frozen plasma and cryoprecipitate. Conclusion: The liver, directly involved in the acute phase reaction, is the main responsible for neutralization of animal toxins. Any patient with history of liver cirrhosis bitten by a venomous snake, even those whose venoms present low risk of coagulopathy, should be very carefully monitored for venom-induced consumptive coagulopathy (VICC), since the hemostatic balance may be disrupted.
Keywords: Snakebite, Liver cirrhosis, Coagulopathy