Clinical Outcomes of Hematotoxic Snakebite Managed with Antisnake Venom–Guided Therapy

Background: Snakebite remains a major medical emergency in rural India, frequently associated with rapidly progressive and life-threatening complications. We report the case of a 45-year-old previously healthy male farmer who sustained a Russell’s viper bite. He initially presented with localized limb swelling and prolonged whole blood clotting time and was treated with anti-snake venom (ASV). Six hours later, he developed hematuria, hypotension, respiratory distress, and hemoptysis. Chest imaging revealed bilateral pulmonary infiltrates consistent with alveolar hemorrhage. Laboratory evaluation demonstrated severe coagulopathy and thrombocytopenia, progressing to disseminated intravascular coagulation and acute kidney injury with oliguria, necessitating hemodialysis. With worsening of the patient’s condition, a tele-ICU consultation was sought, which advised escalation of ASV therapy, proving to be the critical turning point in his clinical course. The patient showed significant clinical improvement and was discharged in stable condition on day eleven. This case underscores the lifesaving role of guided ASV escalation and the value of collaborative e-critical care in managing severe envenomation in resource-limited settings. Keywords: Russell Viper Bite, Hematotoxic Envenomation, Venom-Induced Consumption Coagulopathy, Anti-Snake Venom, Whole Blood Clotting Time.