Snake envenomation in a dog Elizabeth G. Welles* Merrilee Holland** Auburn University, *Department of Pathobiology, **Department of Clinical Sciences Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Signalment and history 7 yr old, F/S, mixed breed dog, 39 kg Bitten by a venomous snake evening of Owner, a veterinarian, administered cephalexin, sucralfate, and dexamethasone Next morning – hematuria Admitted to AUSAC on Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Southeastern venomous snakes copperhead, rattlesnakes, cotton mouth, coral snake Crotalid venom Enzymatic and non-enzymatic proteins –Hyaluronidases, collagenases – facilitate venom entry into blood and tissues –Phospholipases – injure endothelium  inflammation, pain, vasculitis  loss of fluid  hemoconcentration, hypovolemia –Fbrinolytics, anticoagulants, procoagulants  defibrination  prolonged APTT, PT, TT, impaired platelet function, increased FDPs Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Parameter (ref interval) Hct (%) (37-55)42.1 WBC(/ul) (6,000-17,000)19,200 Neutrophils (3,000-11,400)17,490 Lymphocytes (1,000-4,000)769 Platelets(/ul) (164, ,000)378,000 Total protein (g/dl) ( )7.9 ALP (U/L) (4-95)251 ALT (U/L) (26-200)215 AST (U/L) (15-50)596 CK (U/L) (2-357)5,272 Urine specific gravity1.007 Urine protein (mg/dl) (<15)633 Urine blood+3, sed rbc TNTC Prothrombin time (sec) ( )17.5 APTT (sec) ( )21.4 Thrombin time (sec) (7.6-22)>60 Fibrinogen (mg/dl) ( )<15 D-Dimer (ng/ml) (1-250)>2,000 Plasma FDP (ug/dl) (0-5)>20 Patient was treated with antivenom, fresh frozen plasma, IV fluids, antibiotics, hydromorphone Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Parameter (ref interval) Hct (%) (37-55) WBC(/ul) (6,000-17,000)19,20014,450 Neutrophils (3,000-11,400)17,49011,705 Lymphocytes (1,000-4,000)7691,879 Platelets(/ul) (164, ,000)378,000376,000 Total protein (g/dl) ( ) ALP (U/L) (4-95) ALT (U/L) (26-200)21538 AST (U/L) (15-50)59629 CK (U/L) (2-357)5, Urine specific gravity1.007 Urine protein (mg/dl) (<15)633 Urine blood+3, sed rbc TNTC Prothrombin time (sec) ( )17.5 APTT (sec) ( )21.4 Thrombin time (sec) (7.6-22)>60 Fibrinogen (mg/dl) ( )<15 D-Dimer (ng/ml) (1-250)>2,000 Plasma FDP (ug/dl) (0-5)>20 Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Blood smear Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Severity of envenomation estimated from fresh blood smears Echinocytes  echinospherocytes  spherocytes Echinocyte formation (I, II, III) self-limiting (48 hours) Lecithin  lysolecithin (via phospholipase A 2 ) – outer membrane leaflet Progression to echinospherocyte stage or beyond is irreversible Cells sphere and lyse or removed by macrophages Vet Path 1987;24: Vet Path1997;34: Outer leaflet Inner leaflet normal discocytesechinocytes echinospherocytesspherocytes Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Vet Path1997;34: Discocyte (normal biconcave) Echinospherocytes Echinocytes Spherocytes Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only

Blood smear Presented at SEVPAC 2008 – Permission granted for use on SEVPAC website only