A 60-year-old male with bloody diarrhea and altered mental status secondary to a suspected intravascular crotalid envenomation.

We present the case of a 60-year-old male who presented to our emergency department approximately 2 hours after a suspected intravascular pit viper envenomation to the area of the left ankle. By his arrival to our facility he was profoundly confused and hypotensive with bloody diarrhea, coagulopathy and multi-organ dysfunction including renal insufficiency, non-ST elevation myocardial infarction, lactic acidosis and hemoconcentration. His only cutaneous sign of envenomation was a small (1-2 cm) area of ecchymosis adjacent to the Achilles tendon on the lateral aspect of the ankle. He was given aggressive crystalloid resuscitation for circulatory support and received 20 vials of Cro-fab (10 vials 2 hours apart) and 2 units of FFP in the Emergency Department. The patient ultimately had resolution of his coagulopathy and was discharged on hospital day five with no long term sequela.