Hyponatraemia and seizures in Merrem\u2019s hump-nosed pit viper (Hypnale hypnale) envenoming: a case report

Umesh De Silva,Chamara Sarathchandra,Hemal Senanayake,Anjana Silva,Senaka Pilapitiya,Sisira Siribaddana

doi:10.1186/s13256-018-1756-2

Umesh De Silva, Chamara Sarathchandra + Show 4 more

Open Access

https://doi.org/10.1186/s13256-018-1756-2

Copy DOI

Abstract

BackgroundHump-nosed pit vipers (Genus: Hypnale) are medically important snakes in Sri Lanka and South India. Merrem’s Hump-nosed pit viper (Hypnale hypnale) frequently leads to potentially fatal envenomings in Sri Lanka and India. Venom-induced consumption coagulopathay (VICC), local envenoming and acute kidney injury (AKI) are the commonest effects of the envenoming by this snake.Case presentationWe report a previously unreported presentation of H. hypnale envenoming, with an isolated urinary salt loss leading to moderate hyponatraemia resulting seizures. The patient was treated with careful fluid and electrolyte management. No antivenom is currently available for H. hypnale envenoming.ConclusionIn the absence of any evidence of venom induced consumptive coagulopathy, acute kidney injury and cerebral haemorrhage, we hypothesize that this effect is likely due to the presence of a natriuretic peptide in H. hypnale venom, similar to the natriuretic peptides identified in few other snake venoms.

Highlights

Hump-nosed pit vipers (Genus: Hypnale) are medically important snakes in Sri Lanka and South India
In the absence of any evidence of venom induced consumptive coagulopathy, acute kidney injury and cerebral haemorrhage, we hypothesize that this effect is likely due to the presence of a natriuretic peptide in H. hypnale venom, similar to the natriuretic peptides identified in few other snake venoms
We report previously unreported presentation of H. hypnale envenoming leading to hyponatremia, hypovolemia, urinary salt loss and generalize tonic-clonic seizures

Summary

Conclusion

In the absence of any evidence of venom induced consumptive coagulopathy, acute kidney injury and cerebral haemorrhage, we hypothesize that this effect is likely due to the presence of a natriuretic peptide in H. hypnale venom, similar to the natriuretic peptides identified in few other snake venoms.

Background

Findings

Discussion and conclusions