Hump nosed viper bite in Sri Lanka-descriptive observational study of 1543 cases

Abstract

Objective: To identify the clinical manifestations of hump nosed viper envenomation and to recognize the available treatment methods to prevent complications. Methods: Descriptive observational study involving a series of 1543 patients admitted with hump nosed viper bite to 5 major hospitals in Sri Lanka was conducted. Data collection was done consecutively during February 1990 and February 2008. Except Hypnale, identification of the biting snake was made by the corresponding author after visual examination of the dead or live snakes, which were brought to hospital. Results: Sixty seven (4.34%) patients developed systemic effects and two (0.1%) patients died due to effects of envenomation or complications of treatment. Systemic effects varied from coagulopathy, nephropathy to some neurological manifestations. Fifty nine (3.8%) patients had only coagulopathy and they received either, intravenous isotonic saline to ensure adequate urine out put i.e. 0.5 mL/kg /hour or 15 mL/kg of fresh frozen plasma (FFP). None of the patients that had coagulopathy developed renal failure. Contamination of the sample by mildly venomous species of Hypnale may have contributed to the low incidence of systemic complications. Conclusions: It is likely that early hydration with normal saline or FFP can prevent acute renal failure. FFP showed a tendency for early correction of coagulopathy. Role of FFP in hump nosed viper envenomation is worth studying in randomized double blind controlled clinical trials.