Copperhead envenomations: Clinical profiles of three different subspecies

Copperhead envenomation cases reported in the literature frequently lack id entification of the subspecies of copperhead responsible for the envenomati on. Whether subspecific identity would be useful in predicting possible dif ferent toxicity profiles may have clinical relevance. We report here the cl inical profiles from envenomations involving 3 different subspecies of capt ive adult copperhead snakes-the southern copperhead (Agkistrodon contortrix contortrix), the northern copperhead (Agkistrodon contortrix mokasen), and the broad-banded copperhead (Agkistrodon contortrix laticinctus). The bite s occurred in the north-central region of the US where none of these subspe cies are endemic and involved a professional and 2 amateur herpetologists. The victims were adult males with no previous history of venomous snake bit e, and all bites were evidenced by fang puncture marks to their index finge r or thumb. Envenomations from the broad-banded and northern copperhead sub species caused localized symptoms of pain, edema and ecchymosis. In additio n to these symptoms, southern copperhead envenomation resulted in a more se vere clinical toxicity profile as evidenced by propulsive emesis, diarrhea and hematuria. Whether these differences in observed clinical toxicity were the result of unique subspecific venom pharmacological actions is an inter esting question. However, independent of the copperhead subspecies involved , conservative medical management was effective in each case.