When Every Minute Counts (Lessons from Epifanio’s Case and His Fatal Outcome After a Snakebite)

This November 2025, we received a request for support in the case of Mr. Epifanio, a 71-year-old farmer from the state of Lara. His family contacted us seeking guidance because he had suffered a snakebite accident and his condition was not progressing as expected.

Initial Account of the Accident

While picking tomatoes on his plot of land, he was suddenly bitten by a snake.

Mr. Epifanio tried to kill it by throwing a stone so he could take it to the hospital as a reference, but the pain and shock were so intense that he couldn’t do it and eventually fainted. It’s important to remember that attempting to kill or capture a snake increases the risk of a second accident and wastes valuable time; many new envenomations occur precisely during these attempts.

Without immediate support—and believing it might help—he applied deer urine intramuscularly, a traditional remedy with no medical benefit that can introduce bacteria or toxins. Moreover, these practices worsen injuries, significantly delay the start of proper treatment, and create false expectations that give a misleading sense of safety at a critical moment.

His relatives managed to transport him from the rural area to Barquisimeto, but various setbacks prolonged the journey. He arrived at the hospital at night, several hours after the bite, and received medical care with an initial administration of polyvalent antivenom, with the diagnosis.

Case Evaluation and Initial Observations

From the Foundation, we began remote support for the family. With the information available, several elements stood out:

• The edema remained limited to the hand, without rapid progression to higher segments.

• Laboratory tests showed subtle alterations in kidney function that could worsen without close monitoring.

• Serum calcium was low, a finding that can occur in envenomations caused by Crotalus (rattlesnake) due to myotoxicity.

These elements, along with the absence of systemic bleeding, led us to suspect that this was not a Bothrops (mapanare) envenomation, but rather a Crotalus (rattlesnake) accident, where the priority is to protect kidney function from the very beginning.

The antivenom used was appropriate —in Venezuela, Biotecfar polyvalent antivenom is used, effective for both Bothrops and Crotalus— but in rattlesnake cases, the required doses are usually higher and must be administered continuously, diluted, and under strict control, especially due to the risk of severe myotoxicity.

Critical Aspects in Rattlesnake Envenomation

In crotalic envenomation, the myotoxic toxin can rapidly destroy muscle and release myoglobin, which in turn can cause acute kidney injury. This is why the following are essential:

• Early and sustained hydration from the very start.

• Strict renal monitoring, with frequent checks of creatinine, urea, urine output, and electrolytes.

• CK (creatine phosphokinase) and LDH, essential for evaluating the magnitude of rhabdomyolysis.

• Considering urinary alkalinization with sodium bicarbonate in selected cases, under medical supervision.

• Reassessing the patient at 24 hours: if symptoms or signs persist, the corresponding additional antivenom dose must be administered.

Medical literature shows that crotalic accidents can evolve poorly when these measures are delayed.

Support for the Family

Thanks to the information the family sent us, we were able to suggest the need for additional tests—such as CK and LDH—and emphasize the importance of continuous renal monitoring. The family communicated these concerns to the healthcare team, and the studies were later ordered, allowing for a more complete evaluation.

The clinical picture, however, continued progressing slowly, with signs of systemic involvement requiring timely and sustained interventions. The patient’s age and history of hypertension increased the risk of progressive kidney injury.

Final Outcome

Despite the family's constant concern, the support they provided, and the efforts to guide the necessary measures, Mr. Epifanio’s condition continued to worsen. A few hours ago, we received the news of his passing. His family showed admirable dedication throughout the entire process, and from the Foundation, we once again extend our respect and support during this difficult time.

Educational Reflections

This case reminds us of the importance of:

• Not delaying medical attention after a snakebite. Every hour counts.

• Avoiding traditional remedies or unfounded practices that can worsen the condition or delay proper treatment.

• Correctly classifying the type of envenomation, since management priorities differ significantly between Bothrops and Crotalus.

• Administering antivenom properly, diluted and in continuous infusion, never as boluses.

• Monitoring kidney function from the beginning, especially in older patients or those with comorbidities.

• Reassessing the case at 24 hours and adjusting treatment if signs of envenomation persist.

Conclusion

In Venezuela, where Bothrops accidents are more common, it is understandable that many clinical teams prioritize coagulation disorders. However, this case shows how rattlesnake envenomations require a different approach. Continuous education on snakebite management is essential to improve outcomes and save lives.

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