A retrospective review of early gastrointestinal symptoms in the prediction of crotaline envenomation severity

Abstract

Objectives: Rattlesnake envenomations are cited to cause gastrointestinal (GI) symptoms, which may be indicators of systemic envenomation. We sought to identify whether the presence of early GI symptoms, defined as occurring within 4 hours of the bite, could be used to predict antivenom use or bite severity.

Methods: We performed a retrospective review of a statewide poison system's database for all cases of rattlesnake envenomation from January 2000 to December 2009. Data collected included presence of GI symptoms and antivenom use. The GI symptoms were further classified as early (within 4 hours) or late. Bite severity was determined using the minimal to moderate to severe scoring system from collected data. Data were then analyzed with a χ(2) test and Fisher's exact test to evaluate for association between early GI symptoms and either antivenom use or bite severity.

Results: There were 2570 reported rattlesnake exposures in the database. Sixty-one (2.4%) of these had GI symptoms reported. Of these, 36 (59%) had symptoms develop within 4 hours of envenomation. A total of 49 patients (80%) received antivenom. Early GI symptoms were seen in 31 (63%) of patients receiving antivenom versus 5 (42%) of patients not receiving antivenom (P = .20). Early GI symptoms were seen in 4 of 6 (66%) of the severe group, 19 of 29 (66%) of the moderate group, and 13 of 26 (50%) of the minimal group (P = .47).

Conclusions: Gastrointestinal symptoms after rattlesnake envenomations were rarely reported in this poison center study, and the presence of early GI symptoms did not predict bite severity or the use of antivenom.