Article ; Online: Hump-Nosed Pit Viper Envenomation in Western Coastal India: A Case Series.
Wilderness & environmental medicine
2022 Volume 33, Issue 4, Page(s) 399–405
Abstract: The hump-nosed pit viper (HNPV) has historically been considered less medically significant, causing local envenomation, renal injury, and coagulopathy; however, now, it is known to cause life-threatening complications. We describe the clinical ... ...
| Abstract | The hump-nosed pit viper (HNPV) has historically been considered less medically significant, causing local envenomation, renal injury, and coagulopathy; however, now, it is known to cause life-threatening complications. We describe the clinical presentation, treatment, and complications of 3 confirmed HNPV bites from the state of Karnataka (southwest coastal India). Patient 1, an 88-y-old woman, reported with the live specimen and developed venom-induced consumption coagulopathy (VICC) and thrombotic microangiopathy leading to acute kidney injury requiring blood product transfusions and dialysis. Patient 2, a 60-y-old woman, reported 3 d after envenomation followed by treatment at another hospital where 30 vials of polyvalent anti-snake venom (ASV) were given. She developed VICC and acute kidney injury requiring dialysis. On Day 9 of treatment, she developed a pontine hemorrhage. She died after a transfer to another treatment center closer to her residence. Patient 3, a 25-y-old man, was brought to our emergency department 6 h after being envenomed. He received topical ayurvedic treatment before arrival. He was unconscious and found to have severe VICC with a massive middle cerebral artery infarct. All 3 patients received Indian polyvalent ASV, which does not cover HNPV envenomation, clearly demonstrating the absence of paraspecificity and neutralization in a clinical setting. To our knowledge, Hypnale hypnale envenomation has not previously been reported from Karnataka state. The diagnosis of HNPV envenomation in a country without snake venom detection kits, under-reporting despite serious complications, financial burdens on rural populations afflicted, and poor outcomes due to the lack of a specific antivenom are discussed. |
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| MeSH term(s) | Male ; Animals ; Female ; Humans ; Crotalinae ; Snake Bites/complications ; Snake Bites/therapy ; Crotalid Venoms/adverse effects ; India ; Antivenins/therapeutic use ; Blood Coagulation Disorders/etiology ; Disseminated Intravascular Coagulation/chemically induced ; Acute Kidney Injury/etiology ; Acute Kidney Injury/therapy ; Viper Venoms/adverse effects |
| Chemical Substances | Crotalid Venoms ; Antivenins ; Viper Venoms |
| Language | English |
| Publishing date | 2022-10-11 |
| Publishing country | United States |
| Document type | Case Reports |
| ZDB-ID | 1238909-2 |
| ISSN | 1545-1534 ; 1080-6032 |
| ISSN (online) | 1545-1534 |
| ISSN | 1080-6032 |
| DOI | 10.1016/j.wem.2022.08.006 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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