Venom-Induced Consumption Coagulopathy Unresponsive to Antivenom After Echis carinatus sochureki Envenoming.

This research article investigates the complications of snakebite poisoning in the Indian subcontinent, focusing specifically on the Echis carinatus sochureki snake. The study examines a case where the existing Indian polyvalent antivenom was ineffective in treating venom-induced consumption coagulopathy, proposing the necessity of region-specific treatments.

Overview of Snakebite Envenoming and Antivenom in India

• The Indian subcontinent suffers significantly from snakebite envenoming, a hazard that is often overlooked compared to other health problems.
• The common venomous snakes in the region include the Indian cobra, common krait, Russell’s viper, and the Indian saw-scaled viper.
• The Indian polyvalent antivenom, used commonly to treat snakebite victims, is derived from hyperimmunized horse antibodies and works against the major four types of snakes.

Case of Echis carinatus sochureki Envenoming

• In the Thar Desert regions of Rajasthan, a subspecies of the Indian saw-scaled viper, Echis carinatus sochureki, has been linked to serious health issues.
• A case is presented where a patient suffered from venom-induced consumption coagulopathy following a bite from this snake. Coagulopathy is a disturbance in the blood’s ability to clot – the venom typically causes a drastic drop in clotting factors leading to risk of severe bleeding.
• Despite treatment with the Indian polyvalent antivenom, the patient did not show improvement, and only started recovering after a week of supportive care.

Implications and Recommendations

• Research indicates that the venom of Echis carinatus sochureki contains different components in comparison to Echis carinatus, and hence cannot be neutralized effectively by the Indian polyvalent antivenom.
• Healthcare professionals working in areas with a high occurrence of Echis carinatus sochureki bites should be aware of the potential ineffectiveness of the standard treatment and consider this possibility when dealing with non-responsive patients.
• The study advocates for region-specific antivenom or monovalent antivenom (an antivenom designed to counteract the venom of a specific snake) for regions like the Thar Desert, given the ineffectiveness of Indian polyvalent antivenom against Echis carinatus sochureki bites.