Case Report

Suicide Attempt by the Intravenous Injection of Rattlesnake Venom

Authors: David L. Morgan, MD, Hollie W. Blair RPH, Ryan P. Ramsey, MD

Abstract

A 14-year-old male milked the venom from a rattlesnake and injected it with a syringe into his right antecubital vein in a suicide attempt. He immediately developed severe pain and vomiting, then hypotension, swollen lips and tongue, and coma. The injection site did not have the considerable tissue damage seen with severe rattlesnake envenomation. Critical hematological abnormalities, gastrointestinal bleeding, and hematuria developed over 24 hours. He received crotalidae polyvalent immune fab (ovine) antivenom and was discharged after 5 days without sequela. This patient’s clinical findings were similar to those seen in patients bitten by rattlesnakes with rare intravenous envenomation.


Key Points


* Suicidal patients may inject unusual substances intravenously.


* Clinical findings of self-inflicted rattlesnake venom injected intravenously appear similar to those of the rare intravenous (IV) envenomation from a rattlesnake bite.


* IV envenomation of rattlesnake venom causes immediate vomiting, coma, hypotension, and swelling of the face, followed by severe hematological abnormalities and bleeding.


* Antivenom administration should focus on the systemic findings, not on the local reaction.

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