Case Series of Snakebites and Complicated Pit Viper Envenomation Management: Retrospective Experience from a Tertiary-Level Hospital in Central America

Snakebite envenomation is a neglected tropical disease, prevalent in Panama, having the highest incidence rate in Central America. There are currently no national management guidelines or local antivenom production available. Currently, we use regional polyvalent antivenom and recommendations from Central American institutions. Additionally, there is a significant lack of data and published information on the epidemiological and clinical aspects of snakebites in Panama. Providers in Panama conducted an exploratory study on snakebites in Panama's main reference public hospital. A total of 27 cases were analyzed, primarily in men aged 40-49 years. A total of 40.7% of snakes were identified at the genus level, with Bothrops, Micrurus, and Lachesis being the most common. A total of 88.9% of cases were classified as bothropic, whereas 7.4% were classified as elapidic, and 3.7% were classified as colubrid; 18.5% of cases were classified as mild, whereas 48.1% were classified as moderate, and 29.6% were classified as severe. The most common local symptoms (96%) included swelling, erythema, pain, and bleeding at the bite site, with bleeding as the primary systemic symptom. Of the 27 cases, 12 patients (44.4%) developed complications, totalling 22 events. Common complications included life-threatening venom-induced coagulopathy and oliguric acute kidney injury. No deaths were recorded. Antibiotic use was noted in 77.8% of cases. These cases highlight the urgent need to reassess snakebite classification and local species knowledge. National guidelines that consider antibiotic stewardship are necessary, along with research on snakebite management, complications, and disability follow-up in Panama.