Olives Travis D, Topeff Jill M, Willhite Laurie A, Kubic Virginia L, Keyler Daniel E, Cole Jon B
a Regions Toxicology Education & Clinical Service , St. Paul , MN , USA ;
b Minnesota Poison Control System , Minneapolis , MN , USA ;
Clin Toxicol (Phila). 2016 Mar;54(3):290-2. doi: 10.3109/15563650.2016.1138227. Epub 2016 Feb 2.
Protobothrops mangshanensis, the Mangshan pit viper, is a rare pit viper native to the area surrounding Mount Mang in China's Hunan province. Toxicity from envenomation is not well characterized.
A 33-year-old male presented to an emergency department (ED) after being bitten on the forearm by his P. mangshanensis. He complained of mild swelling and pain at the bite site. He was admitted for observation and toxicology consultation. Following initially normal coagulation studies including platelets, prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen and D-dimer, fibrinogen decreased to 121 mg/dL and D-dimer concurrently rose to 377 ng/mL over 24 h. On hospital day 2 fibrinogen stabilized at 109 mg/dL and he was discharged with outpatient laboratory monitoring. Three days later, he returned with bruising to the contralateral arm. Fibrinogen was undetectable (<40 mg/dL) and PT was 14.6 s. He declined admission but returned 2 d later with bruising to the nose. Bloodwork revealed immeasurably prolonged PT, aPTT, and thrombin time, but he eloped. Late that evening he returned and was treated with three vials of Green pit viper (Trimeresurus albolabris) antivenom. Within 24 h coagulopathy improved markedly; at five days, coagulation abnormalities resolved.
Mangshan pit viper envenomations may cause isolated hemotoxicity, despite molecular studies suggesting additional neurotoxicity and myotoxicity. T. albolabris antivenom appears effective in treating the resultant coagulopathy.
We report the natural history of envenomation by the Mangshan pit viper. A delayed coagulopathy, apparently fibrinolytic in nature, is unaccompanied by local tissue destruction and responsive to Green pit viper antivenom.
莽山烙铁头蛇（Protobothrops mangshanensis）是一种原产于中国湖南省莽山周边地区的珍稀蝰蛇。其咬伤后的毒性特征尚不明确。
一名33岁男性被其莽山烙铁头蛇咬伤前臂后前往急诊科就诊。他主诉咬伤部位有轻度肿胀和疼痛。他入院接受观察及毒理学会诊。最初包括血小板、凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）、纤维蛋白原和D - 二聚体在内的凝血检查结果正常，但在24小时内纤维蛋白原降至121mg/dL，同时D - 二聚体升至377ng/mL。住院第2天，纤维蛋白原稳定在109mg/dL，他出院并接受门诊实验室监测。三天后，他因对侧手臂出现瘀伤再次就诊。纤维蛋白原检测不到（<40mg/dL），PT为14.6秒。他拒绝住院，但两天后因鼻子出现瘀伤再次返回。血液检查显示PT、aPTT和凝血酶时间显著延长，但他擅自离开。当晚晚些时候他又回来，接受了三瓶竹叶青蛇（Trimeresurus albolabris）抗蛇毒血清治疗。24小时内凝血障碍明显改善；五天时，凝血异常得以解决。
尽管分子研究表明莽山烙铁头蛇咬伤可能还存在神经毒性和肌毒性，但实际咬伤可能仅导致单纯的血液毒性。竹叶青蛇抗蛇毒血清似乎对治疗由此导致的凝血障碍有效。
我们报告了莽山烙铁头蛇咬伤的自然病程。一种延迟性凝血障碍，本质上显然是纤维蛋白溶解型的，无局部组织破坏且对竹叶青蛇抗蛇毒血清有反应。
