envenomation in a dog: clinical, hemostatic and thromboelastometric findings and treatment.

CONTEXT

is endemic to the Middle East. Clinical reports describing envenomation in humans are scarce, while natural envenomations of animals were not reported. Such envenomations may induce systemic coagulopathy. This report describes a confirmed envenomation in a dog, with assessment of the global hemostasis by thromboelastometry.

CASE DETAILS

A 6-year old Belgian Shepherd dog was presented in shock, mucosal bleeding and swelling due to snakebite. Laboratory tests showed prolonged prothrombin and activated partial thromboplastin times. Because is the most common venomous snake in Israel, immunoglobulin-G monovalent antivenom was administered, with supportive care. The dog improved clinically, was discharged, and was readmitted, with active bleeding from the bite site. The dead snake was only then identified as . Thromboelastometry demonstrated severe hypocoagulability. The dog was treated with polyvalent antivenom directed against venoms of several Middle Eastern snakes, fresh-frozen plasma and packed red blood cells. Bleeding completely ceased, and thromboelastometry results improved. The dog was discharged. 3 days later, all hemostatic test results had normalized.

DISCUSSION

Thromboelastometry is useful for assessing the hemostatic status in envenomation, and for monitoring and managing the venom-induced coagulopathy, and guide plasma and polyvalent antivenom treatment.