Is D‐dimer the new test for venom‐induced consumption coagulopathy after snakebite?

Mark Little
Med J Aust 2022; 217 (4): . || doi: 10.5694/mja2.51663
Published online: 15 August 2022

Despite its potential value, a number of questions require answers before its role in clinical practice becomes clear

For many clinicians working in rural Australia, people bitten by snakes can present significant diagnostic and logistical challenges. The current advice is that these patients be managed in a hospital with a laboratory, antivenom, and clinicians who can manage the complications of both the envenoming (such as neurotoxicity) and the antivenom (anaphylaxis).1 As many rural hospitals have limited or no immediate access to laboratories, patients (many of whom are not envenomed) must be transported hundreds of kilometres, often after hours. As envenomed patients do better if antivenom is administered early, delaying its provision can increase the risks of complications. Consequently, simple and accurate bedside investigations for diagnosing or excluding envenoming are urgently required, both in Australia and overseas.2

  • 1 Cairns Hospital, Cairns, QLD, Australia
  • 2 NSW Poisons Information Centre, Children's Hospital at Westmead, Sydney, NSW, Australia

Competing interests:

I am a toxicologist employed at the NSW Poisons Information Centre and give advice to doctors managing snakebites. I am the editor of two textbooks, Toxicology handbook, third edition (Murray L, Little M, Pascu O, Hoggett K, eds; Sydney: Elsevier, 2015) and Adult emergency medicine, fifth edition (Cameron P, Little M, Mitra B, Deasy C, eds; Edinburg: Elsevier, 2020) in which the management of snakebite is discussed. I assisted CSL in reviewing the book A clinician’s guide to Australian venomous bites and stings (White J, ed; Melbourne: CSL, 2013).

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