Copperhead Envenomations In The Carolinas

Introduction: Although the copperhead (Akistrodon contortrix) is responsible for most Crotaline envenomations in the Carolinas, manifestations and treatment are poorly characterized. Objective: We sought to describe the clinical course after copperhead bites. Method: Structured review of copperhead exposures reported to a regional poison center from 1997-2000. Hospital records were reviewed when available. Phone followup was attempted. Results: A total of 178 cases were identified. Of these 75% were males. The median age was 31 yr (range 2-93). The bite site included hand (52%), foot (36%), leg (7%), and arm (5%). Classification included dry (7%), mild (48%), moderate (39%), and severe (6%). The most common symptom was pain (93%). Local findings included swelling (94%), fang marks (93%), ecchymosis (53%), erythema (37%), bullae (13%), and tissue necrosis (8%). Eleven of 37 patients developed abnormal PT and or PTT. Two patients bled. Patients were treated at a healthcare facility in 160 cases, with 79 patients admitted. Opioid analgesics were the most common therapy (81%). Equine-derived antivenin was given in 14 cases (range 2-30 vials). Antivenin reactions developed in three. Two patients received blood products. Surgical treatment included debridement (6), grafting (2), digit amputation (1), digit dermotomy (1), and fasciotomy (1). No patients died. In followup, 18 patients reported limb dysfunction ranging from 5-365 days. Conclusion: Copperhead bites typically result in mild to moderate envenomation due to local tissue effects. Significant systemic manifestations are rare. Limb dysfunction can be prolonged.