A case of severe systemic copperhead (Agkistrodon contortrix) envenomation with shock

We report a case of severe systemic copperhead (Agkistrodon contortrix) envenomation presenting with shock and minimal initial tissue injury. The patient required intravenous fluid resuscitation and a vasopressor infusion but improved with administration of high doses of Fab antivenom. He had resolution of his hypotension with antivenom, and his tissue injury progressed beyond his entire arm. He eventually stabilized with further antivenom and was discharged. Although A. contortrix envenomations are not typically severe, this case demonstrates that these bites can present with severe systemic clinical manifestations. Clinicians should focus on the management of the individual patient rather than determining therapy based solely on the offending species.