CANEBRAKE RATTLESNAKE ENVENOMATION

Study objective: To document the clinical presentation and course of c onsecutive cases of envenomation by the canebrake rattlesnake (Crotalu s horridus atricaudatus). Methods: The medical care provided all patie nts envenomated by canebrake rattlesnakes in two institutions was retr ospectively reviewed. Particular attention was paid to coagulation abn ormalities, serum enzymes, electrocardiographic findings, and treatmen t with antivenom. Results: Of the 15 patients, envenomation was judged to be mild in 3, moderate in 6, and severe in 5. In one case envenoma tion caused death. The clinical course generally predicted the degree of increase in the serum creatinine kinase (CK) level, as well as the amount, of antivenom used for treatment. Despite increases in serum CK concentration and frequent increases in the serum CK-MB fraction, we found no evidence of cardiac damage. Conclusion: In envenomation by No rth American pit vipers, rhabdomyolysis appears to be characteristic o f envenomation by the canebrake rattlesnake. We speculate that toxins in the canebrake venom cause skeletal muscle rhabdomyolysis. Physician s caring for victims of canebrake bite should regard marked increases in CK concentration as coming from skeletal, not cardiac, muscle. Good general medical support and antivenom for victims with moderate to se vere envenomation appears effective.