A single venom contains a wide array of toxins—necrotoxins, pre- and postsynaptic neurotoxins, and nephrotoxins, among others. This complexity, along with other biological factors, makes it difficult in clinical practice to predict specific effects of an individual envenomation.1,2*
1. Smith J, Bush S. Envenomations by reptiles in the United States. In: Mackessy SP, ed. Handbook of Venoms and Toxins of Reptiles. Boca Raton, FL: CRC Press; 2010:475-488. 2. Lavonas EJ, Ruha AM, Banner W, et al. Unified treatment algorithm for the management of crotaline snakebite in the United States: results of an evidence-informed consensus workshop. BMC Emerg Med. 2011;11:2. 3. Lavonas EJ, Khatri V, Daugherty C, Bucher-Bartelson B, King T, Dart RC. Medically significant late bleeding after treated crotaline envenomation: a systematic review. Ann Emerg Med. 2014;63(1):71-78. 4. Yip L. Rational use of crotalidae polyvalent immune Fab (ovine) in the management of crotaline bite.[comment] Ann Emerg Med. 2002;39:648–650.