Abstract
Abstract: Even though the Hump-nosed pit viper bite is the commonest venomous snake bite in Sri Lanka, antivenoms with specific activity against it are not available. Acute kidney injury (A.K.I.) is an important systemic complication accounting for mortality. Therapeutic plasma exchange (TPE) and fresh frozen plasma (F.F.P.) are two interventional options hypothesized to prevent A.K.I. This is by TPE at-tenuating venom antigenemia and F.F.P. by inhibiting nephrotoxic renal injury by immunomodulation, and the additional benefit of replenishment of depleted clotting factors triggered by venom-induced con-sumption coagulopathy implicated in the multifactorial mechanisms of renal injury. Routine interventions on all envenomed patients are not justifiable owing to the rarity and sporadic occurrence of systemic complications, and only patients with coagulopathy should be selected for interventions. The benefit of preventing A.K.I. is most likely with early intervention at the inception of coagulopathy.
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