CROTALIDAE ENVENOMATION IN CHILDREN

Poisonous snakebites cause a severe envenomation syndrome in children, yet treatment remains controversial. Sixty-seven patients were treate d for poisonous snakebites at our institution between 1975 and 1990; 1 8 were children less-than-or-equal-to 12 years old. There were 13 ratt lesnake bites, 4 copperhead bites, and 1 unidentified bite. Initial ma nagement included intravenous fluids and antibiotic administration, la boratory studies, tetanus prophylaxis, affected limb elevation, and a limited excision of the bite site in the emergency room. Antivenin was administered only if signs of systemic involvement such as shock, coa gulopathy, gastrointestinal cramping, or neurological involvement were present. Children developed systemic involvement 72% of the time, 9 c hildren (50%) developed coagulopathy. Consequently, 11 (61%) children received antivenin. The dose of antivenin they received was 3.2 ml/kg and the children tolerated it well with only 36% of them demonstrating adverse reactions to the antivenin. Clinically, the pediatric patient s demonstrated signs and symptoms of a fulminant envenomation syndrome (8 days, average hospital stay), yet, they had a good eventual outcom e. Only 11% of children reported long-term morbidity. No deaths occurr ed and 100% of patients were able to return to full preinjury activiti es. We conclude that Crotalidae envenomation in children is a serious disease and warrants hospitalization, early surgical involvement, and frequent use of antivenin.