Envenoming by snake: a patient with liver cirrhosis presenting disruption of hemostatic balance.

J Venom Anim Toxins Incl Trop Dis 2017 14;23:10. Epub 2017 Feb 14.

Department of General Surgery, Chang-Gung Memorial Hospital, Keelung Branch, 222, Maijin Road, Keelung, Taiwan.

Background: In most cases of envenoming by the green habu 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 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.

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http://jvat.biomedcentral.com/articles/10.1186/s40409-017-00
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http://dx.doi.org/10.1186/s40409-017-0096-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5310085PMC
February 2017
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