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Emergency protocol for Snake Envenomation of your Pet

Written by:
Gloria Dempsey
Zoologist,
Arenal, Costa Rica

I would like to share some information that just may save the life of your pet or keep from having to
do an amputation later. For those of us living in the outback of Costa Rica, we often have to perform
emergency medical procedures to save the life of our pets when time is of essence, and medical
personnel are too far away. When bitten by theses dangerous pit vipers here in Costa Rica, always
keep in mind that TIME IS OF ESSENCE in determining the outcome of a snake bite victim.
Though there are several species of pit vipers around, they share some, though not all, common
chemicals in their venom. But like individual fingerprints, the venom and toxicity does vary from one
species to another. The most potent venom from these pit vipers here in our area of Arenal -Tilaran
and actually in most of Costa Rica is from the Fer-De-Lance (Tersiopelo). This large and powerful
animal carries very toxic and tissue damaging venom. The other species of pit viper are of course
dangerous, they are simply smaller and deliver less venom, but should be taken seriously with respect
to treatment should your pet be bitten.
The main challenge for us as pet owners is how to know if your pet has been bitten by a snake. Sadly,
they can't tell us, and sometimes it isn't immediately evident. Unless your pet is never out of your
sight, they can get into trouble and you have to make an educated decision to react. If your pet
presents showing great pain, yelping, whining, shivering, etc and showing pronounced swelling, there
is suspect. If you are able to see one or two bloody puncture wounds with the above symptoms, you
can be pretty sure you have a snake bite problem. Now here is the challenge. I have seen two cases
lately in which there was very mild swelling in the first couple of hours and the puncture wounds
were not real noticeable. So I was left with a question as to the possibility of bee/wasp stings. That can
happen too. But it is paramount for you to make the best judgment possible for your pet. Especially
try to find some puncture wound that won't clot. Most pit viper bites contain an anti-coagulant.
What you do in those early hours can make the difference. In these two cases, maximum swelling did
not occur in the first few hours like I normally see. In at least one of them, maximum swelling did not
show until 15 hours later. Had I discounted the urgency during those first hours and decided against
snake bite treatment, we could have lost the little dog. So, the take home here is realize that if it is a
true venomous snake bite, you may not see maximum swelling for many hours later and by that
time, there could be irreversible damage. Also, an interesting phenomenon is that during those first
few hours, the pet may actually begin to look better. But often, in a true envenomation, it is most
likely the body reacting by trying to counteract the venom. However, the venom is so powerful,
eventually they will lose the battle and the swelling will continue and they will get worse.
So,if you have decided that there is sufficient evidence for a snake bite, you need to take prompt
action.
It is important for you to understand what is happening after your pet is bitten. Immediately, they
suffer great pain (humans describe it as holding a torch to your skin!) and shortly after, swelling
will begin at the bite site. The body has been injected with potent tissue destroying chemicals from
the venom. The venom will travel up the lymph vessels quickly and shortly end up in general blood
circulation. During the journey from the bite site, tissue is being destroyed rapidly by powerful
enzymes in the venom. Most notably, muscle tissue is being digested and broken down. Once in the
general blood circulation, components of the blood are being destroyed; red blood cells, platelets,
normal clotting factors, etc. Eventually all of the components of destroyed tissue and blood
components end up being circulated into the kidneys where the small kidney tubules can become
overloaded and clogged and possibly destroy the kidneys. Two dangerous things are going on;
internal hemorrhage, and possible kidney damage. Everything must be done to combat that. Later
you can be dealing with tissue destruction at the bite site.
If you have made the decision to have your pet treated for snake bite, here are some steps you can
take before going to the veterinarian.

It would be nice to know what type of snake bit your pet, but unless it is in the immediate vicinity,
don't waste valuable time looking for it. Because unless it is a coral type snake, all pit viper bites are
treated the same.
Some supportive drugs that are valuable to inject first are a steroid such as dexamethasone, as well
as some type of antihistamine (that can be an oral such as Benadryl). Confir with your vet for proper
dosage. Then, you can proceed as follows: In the best case scenario, if you previously decided that
your pet was at high risk of snake bite and already have anti-venom stored in your fridge, it is best to
go ahead and inject intramuscularly 1 of the 10ml vials of anti-venom. Don't put more than 5 ml in
one muscle if it is a large dog, and only 2ml in one site if it is a small dog. Since you won't be
injecting into a vein (and you shouldn't) try to inject into various muscle sites on the dog's body to
maximize the quickest absorption. You should have already spoken with your vet for a
demonstration of where and how to do an I.M. Injection. Hurry and take your pet to the
veterinarian. If possible, carry your dog to the car, and try to keep your dog as quiet and inactive as
possible, because exercise will only speed up circulation and more tissue damage. Take the rest of the
anti-venom with you to the vet clinic, because there is a good chance that because anti-venom is
expensive, they don't keep it at the clinic and for your pet it is vital for treatment.
At the veterinary clinic here is what (should) happen. (WHEN I SAY "SHOULD", NOT ALL
MEDICAL PERSONNEL ARE WELL VERSED IN THE PHYSIOLOGY OF SNAKE BITE. THIS
IS A SPECIALIZED AREA OF MEDICINE. And because of my concern for my pet, I am not
bashful to point out a step that appears to be omitted. ) Optimally, blood should first be drawn
(assuming they have a blood analyzer machine) to run tests to determine the degree of
envenomation. In true snake bite victims you will see, the following in blood test results; there will
most likely be a decrease in haemoglobin, hematocrit, platelets, clotting factors and often an increase
of some of the white blood cells. A blood kidney profile can show an increase of metabolic products
showing the kidneys are being stressed.
Ideally, a quick sensitivity test to the anti-venom should be done. (on rare occasions an animal can be
allergic to the anti-venom and emergency steps must be taken to make sure they don't go into shock
when the anti-venom is given). If it appears they are not sensitive to the anti-venom you can proceed
with the anti-venom treatment.
Without waiting to get the results of the blood test, an I.V. Should be started and the first vial of antivenom should be introduced into the bag. The drip should be started very slowly over the first 20
minutes to be sure there is not a reaction to the anti-venom. If all appears well, the drip can be
adjusted based on condition of the pet. Actually, in a severe case, more than one vial may be
introduced into the 1 litre bag.
Your pet will most likely have more than one bag (or even several) of fluids to clean the kidneys
before damage can take place. At this point, it is basically a wait and see situation. When receiving
such a volume of fluids, your pet will be urinating frequently. It is best to let the pet urinate where
you can see the colour of the urine. In the beginning, you may notice very dark rust coloured urine.
That contains broken blood components, hemoglobin, myoglobin from muscle breakdown, etc,
Hopefully, over time, the urine will begin to clear as the kidneys are cleaned of the waste products,
and they can return to normal healthy function.
Optimally, each 3 hours, a sample of blood can be analyzed to see how much progress you are
making with the treatment. Normally, based on swelling, colour of the urine, and blood tests, the
decision is made whether to continue the fluids and anti-venom.
If all proceeds well and it is determined that your pooch has passed the crisis, he will be sent home
with some meds to continue over some days. Your vet will make that decision and give you
instructions.
So, the natural question is: Should everyone who has a pet keep anti-venom at home in the fridge?
I personally don't think it is practical. Also, if everyone made a run on the anti-venom supply, most
of the people (hopefully) would never use it. It is expensive (at this writing, June 2011, $75.00 for a

box of 4 vials which will expire in a couple of years). Further, we could all deplete a valuable supply
that may not be available for other snake bite victims in a real crisis. The best thing you can do is to
analyze your risk factor and make that decision. The highest risk factors would be: people with
multiple dogs, who live very remote, and whose dogs frequently venture into the forest. Based on
that, you just have to make that personal choice based on your situation. A thought could be that
you and some of your friends who live close by could chip in on a box (assuming you all have a risk
factor) in the event one of you had an emergency.
If you do decide to purchase it, you would ask for Suero, Antiofidico, Polivalente and I normally
buy it at Dos Pinos vet supply in Tilaran as the closest place to both Nuevo Arenal and Tilaran. It
should be transported cold and kept in your refrigerator (not the freezer).
A note about anti-venom:
All anti-venom is made from one , (mono-valent) or more, (poly-valent) species of snakes native to
the area. In Costa Rica, it is made from the venom of three species of snakes: the fer-de-lance, Bush
Master, and the Central American Rattlesnake. The venom extracted from these three is injected into
horses at approximately 2 weeks intervals, in increasing strengths. During this time, the horses are
producing antibodies to each of those venoms. Eventually, the serum is harvested from the horses
and purified and produced as anti-venom. Most of the venom supplied to all of Central America is
produced in San Jose, Costa Rica at the Clodomiro Picado Instituto. I think they produce 3 or so
batches each year, because it is a lengthy and expensive process.
So you are asking, what if it was one of the other pit vipers that bit my dog? Because many of the
components of these pit viper's venom are shared in common, your dog will receive varying degrees
of protection. It should be noted that anti-venom is extremely helpful to a snake bite victim, but you
should never believe it is a magic bullet, or that by receiving it, is a guarantee your pet will be fine. It
simply stacks the odds in favor of your pet, so in the event of a confirmed snake bite, by all means try
to get anti-venom.
**IT SHOULD BE NOTED:
I am not a veterinarian. I am a microbiologist-zoologist with many years experience with medicine of
both exotics and domestic animals, and have done research with cobra venom, however even though
my suggestions are sound and backed up by doctors in the states, I can not be held responsible for the
outcome of your pet as there are too many factors contributing to the survival. This information is
provided freely in the hopes that it may save the life/ limb of a beloved pet.
****HANDLE ANTIVENOM GENTLY AS ANTIBODIES ARE VERY FRAGILE, MIXING EACH
VIAL SHOULD BE GENTLY ROLLED BACK AND FORTH IN YOUR PALM SO AS NOT TO
BREAK THE ANTIBODIES. ALWAYS KEEP IT COLD IN THE FRIDGE, NEVER IN THE
FREEZER.
Gloria Dempsey,
Zoologist, Arenal, C.R.
revised: June, 2011