Abstract
The Russell's viper (Daboia russelii) is responsible for 30–40% of all snakebites and the most number of life-threatening bites of any snake in Sri Lanka. The clinical profile of Russell's viper bite includes local swelling, coagulopathy, renal dysfunction and neuromuscular paralysis, based on which the syndromic diagnostic tools have been developed. The currently available Indian polyvalent antivenom is not very effective in treating Russell's viper bite patients in Sri Lanka and the decision regarding antivenom therapy is primarily driven by clinical and laboratory evidence of envenoming. The non-availability of early predictors of Russell's viper systemic envenoming is responsible for considerable delay in commencing antivenom. The objective of this study is to evaluate abdominal pain as an early feature of systemic envenoming following Russell's viper bites. We evaluated the clinical profile of Russell's viper bite patients admitted to a tertiary care centre in Sri Lanka. Fifty-five patients were proven Russell's viper bite victims who produced the biting snake, while one hundred and fifty-four were suspected to have been bitten by the same snake species. Coagulopathy (159, 76.1%), renal dysfunction (39, 18.7%), neuromuscular paralysis (146, 69.9%) and local envenoming (192, 91.9%) were seen in the victims, ranging from mono-systemic involvement to various combinations. Abdominal pain was present in 79.5% of these patients, appearing 5 minutes to 4 hours after the bite. The severity of the abdominal pain, assessed using a scoring system, correlated well with the severity of the coagulopathy (p<0.001) and the neurotoxicity (p<0.001). Its diagnostic validity to predict systemic envenoming is – Sensitivity 81.6%, Specificity 82.4%, Positive predictive value 91.2%. Thus, abdominal pain is an early clinical feature of systemic Russell's viper bite envenoming in Sri Lanka. However, it is best to judge abdominal pain together with other clinical manifestations on decision making.
Highlights
The Russell’s viper is considered a highly venomous snake throughout its range in Asia [1]
Three sub species of the Russell’s viper, D. r. pulchella, D. r. nordicus and D. r. russelii have been described from the regions to the west of the Bay of Bengal, based on morphology. These sub species have been placed under Daboia russelii, the taxonomic validity of this separation remains doubtful [2,3]
The Russell’s viper (Figure 1) is responsible for 30–40% of the snake bites, and to the most number of severe envenoming and fatalities compared to other snakes in Sri Lanka [5,6]
Summary
The Russell’s viper is considered a highly venomous snake throughout its range in Asia [1]. Based on the morphology and molecular evidence, the western and the eastern forms of this snake are considered two separate species. Russelii (other areas) have been described from the regions to the west of the Bay of Bengal, based on morphology. These sub species have been placed under Daboia russelii, the taxonomic validity of this separation remains doubtful [2,3]. The Russell’s viper (Figure 1) is responsible for 30–40% of the snake bites, and to the most number of severe envenoming and fatalities compared to other snakes in Sri Lanka [5,6]. In 1910, Abercromby [7] noted ‘‘...they [native Sri Lankans] consider the Russell’s viper (Tic Polonga) as a personification of the devil.’’ Bites by Russell’s vipers commonly occur in paddy (rice) fields and on footpaths at dusk and at dawn, affecting a large number of agricultural workers and so considered an occupational hazard in Sri Lanka [8]
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