UMEM Educational Pearls

Category: Toxicology

Title: Copperhead Snakebite

Keywords: copperhead, crofab (PubMed Search)

Posted: 6/24/2010 by Fermin Barrueto, MD (Updated: 10/14/2019)
Click here to contact Fermin Barrueto, MD

In the state of Maryland, the most common venomous snake is the copperhead. Though not as dangerous as the rattlesnake, it can still cause loss of function of limb and mortality in the pediatric patient.

Treatment has involved the use of CroFab (Protherics, Atlanta). This ovine derived monovalent immunoglobolin is actually made against the following snakes:

  • Eastern diamondback rattlesnake
  • Western diamondback rattlesnake
  • Mojave rattlsnake
  • Cottonmouth (Water moccasin)

Though efficacy has been shown with these snakes, we are hoping for cross-reactivity when we treat copperheads. There are case series and case reports (1) that have shown anectdotal improvement. We are still awaiting a real randomized controlled trial - may never happen.

References

Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite.

Lavonas EJ, Gerardo CJ, O'Malley G, Arnold TC, Bush SP, Banner W Jr, Steffens M, Kerns WP 2nd.

Ann Emerg Med. 2004 Feb;43(2):200-6.