Boomslang (Dispholidus typus)
bites are rare in South Africa. This snake's
venom is known to be potently haemotoxic, producing a consumptive coagulopathy through the activation of
clotting factors II, X, and possibly IX. Monovalent Boomslang
antivenom, produced by the South African
Vaccine Producers, is highly effective in treating patients who present with haemotoxic envenomation. The majority of health care centres in South Africa do not stock this
antivenom due to cost concerns and because envenomation from this snake is so infrequent; this may have lethal consequences for a patient presenting to any such a centre. The usual
antivenom dose for effective treatment of a Boomslang
bite is two 10 ml vials. We present a case of severe Boomslang envenomation, secondary to a man being bitten on bilateral upper limbs while inside his house, which required three vials of
antivenom to treat effectively.