U.S. Department of Defense


Date of this Version





Objective—Annually, more than 100,000 US and international military and civilian personnel work in Afghanistan with in terrain harboring venomous snakes. Current literature insufficiently supports Afghan anti-venom treatment and stocking guidelines. We report the clinical course and treatments for snakebite victims presenting to US military hospitals in Afghanistan.

Methods.—All snakebite victims presenting to 3 US military emergency departments between July 2010 and August 2011 in northern and southern Afghanistan were examined via chart review. Case information included patient demographics, snake description, bite details and complications, laboratory results, anti-venom use and adverse effects, procedures performed, and hospital course.

Results.—Of 17 cases, median patient age was 20 years (interquartile range [IQR],12–30), 16 were male, and 82% were Afghans. All bites were to an extremity, and median time to care was 2.8 hours (IQR, 2–5.8). On arrival, 8 had tachycardia and none had hypotension or hypoxia. A viper was implicated in 5 cases. Ten cases received at least 1 dose of polyvalent anti-venom, most commonly for coagulopathy, without adverse effects. Six received additional anti-venom, 6 had an international normalized ratio (INR) > 10, and none developed delayed coagulopathy. Three received blood transfusions. Hospital stay ranged from 1 to 4 days. None required vasopressors, fasciotomy, or other surgery, and none died. All had resolution of marked coagulopathies and improved swelling and pain on discharge.

Conclusions.—We report the largest series of snake envenomation’s treated by US physicians in Afghanistan. Anti-venom was tolerated well with improvement of coagulopathy and symptoms. All patients survived with minimal advanced interventions other than blood transfusion.