Use of "Near Middle East Antivenom" to treat African bush viper envenomation

Venom from an African bush viper is primarily hemotoxic and potentially life threatening. Existing, commercialy available antivenoms may not neutralize venom of this genus. A 25-y-old male was brought to the emergency room diaphoretic and hypotensive (70/40 mmHg) after a bite from a pet African bush viper. A puncture wound on the left thumb was leaking slightly, but there was no evidence of blood loss, edema or bruising. Approximately 100 min after exposure, the patient experienced a small amount of proximal swelling. Six h after envenomation, he was admitted to the intensive care unit for monitoring. At 10 h after the bite prothrombin time (PT > 100 sec) and international ratio (INR = 9.2) were elevated. The patient was unable to coagulate. He received fresh frozen plasma, cryoprecipitate, and Near Middle East Antivenom. Improvement in clinical status and laboratory parameters were observed after each of 3 doses of antivenom (d-dimer > 1000 and fibrinogen = 137 mg/dL). The patient was monitored overnight, did not require additional antivenom and was discharged as laboratory parameters, vital signs and spread of the necrotic lesion stabilized. Near Middle East Antivenom appears effective in treatment of the hematologic sequelae secondary to African bush viper envenomation.