Cardiac arrest and atrial fibrillation in a patient after hump-nosed pit viper (Hypnale hypnale) bite

Rathnayaka, R.M.M.K. Namal; Ranathunga, P.E. Anusha Nishanthi; Ranaweera, Janaka; Jayasekara, Krishantha; Kularatne, S.A.M.

doi:10.1016/j.toxicon.2018.03.014

Cited by 21 publications

(25 citation statements)

References 19 publications

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“…In Sri Lanka, both hemorrhagic and ischemic cerebral infarction is common with Russell’s viper ( Daboia russelii ) envenoming, and sometimes these may be fatal [ 11 ]. Cardiac effects such as MI, atrial fibrillation, acute ischemic changes, bradycardia, and cardiac arrest have previously been reported following hump-nosed pit viper bites [ 4 , 12 ]. Our patient had bradycardia throughout.…”

Section: Discussionmentioning

confidence: 99%

“…It frequently causes local envenoming and less commonly cause systemic effects such as acute kidney injury and venom-induced consumption coagulopathy (VICC) [ 2 , 3 ]. Myocardial infarction (MI) [ 4 ], Kounis syndrome [ 5 ], microangiopathic hemolysis [ 6 ], thrombotic microangiopathy (TMA), hemolytic uremic syndrome (HUS), and thrombotic thrombocytopenic purpura (TTP) [ 2 , 7 ] are some atypical presentations of hump-nosed pit viper bites. Currently, no antivenom is available for Hypnale bites in Sri Lanka or India, and supportive treatments are carried out for these bites.…”

Section: Introductionmentioning

confidence: 99%

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Acute ischemic stroke: a rare complication of hump-nosed pit viper (Hypnale spp.) bite: a case report

et al. 2022

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Background Hump-nosed pit viper is a medically important deadly venomous snake in Sri Lanka and is the commonest cause of venomous snakebites in the country. It frequently causes local effects and systemic manifestations such as acute kidney injury and coagulopathy that occur in less than 10% of all bites. This also includes some atypical presentations such as thrombotic microangiopathy and myocardial infarction. Currently, no antivenom is available for hump-nosed pit viper bites in Sri Lanka, and patients are managed with supportive treatment. This case illustrates an acute ischemic stroke following a hump-nosed viper bite, which is the second case in the literature. Case presentation A 71-year-old a Sinhalese male patient presented with left-sided hemiparesis with mouth deviation on day 2 of hump-nosed viper (Hypnale spp.) bite on the right foot. Non-contrast computed tomography of brain showed right ischemic stroke in internal capsule. He was given antiplatelets and statins and continued supportive treatment including limb physiotherapy and speech therapy. He recovered completely and was discharged on day 4 with clinic follow-up. Conclusions Physicians should be aware that ischemic cerebral infarcts may occur following hump-nosed pit viper bites.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute ischemic stroke: a rare complication of hump-nosed pit viper (Hypnale spp.) bite: a case report

et al. 2022

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“…Additional histological findings are hyaline membranes due to diffuse alveolar damage (DAD) in three cases [16,24,25] and widespread microthrombosis consistent with a disseminated intravascular coagulation (DIC) in four cases (7.142%) [12,19,20,39]. Renal injuries other than vascular congestion were mainly represented by tubular and/or glomerular necrosis found in 13 cases out of 56 in total (23.214%) [11,15,19,21,24,26,37,39,42]. Cortical and glomerular necrosis has been reported in one single case [30] and widespread ischemic necrosis in a different one [43].…”

Section: Post Mortem Examination Findingsmentioning

confidence: 97%

“…In the brain, other than congestion and edema, petechial hemorrhages from pin-point size to large hematoma in the white matter have been reported in 13 cases out of 56 in total (23.214%) [14][15][16]18,20,[23][24][25]27,39,44]. Microscopically, signs of ischemic and hemorrhagic encephalopathy have been found in six cases out of 56 [14,24,26,28,34,36] and extensive perivascular demyelination in a single case [21] Myocardial hemorrhages have been reported in seven cases out of 56 (12.500%) [12,14,16,27,35,39] and alterations consistent with myocardial infarction in a single case [14]. Signs of rapid failure of the left ventricle were mostly represented by pulmonary edema and congestion.…”

Section: Post Mortem Examination Findingsmentioning

confidence: 99%

Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review

Feola

Marella

Carfora

et al. 2020

Toxins

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Snakebite envenoming (SBE) is a public health issue in developing countries. The estimated annual global incidence of snakebites is about 5.4 million snakebites per year, resulting from 1.8 to 2.7 million cases of SBE and from 81,000 to 138,000 deaths with 400,000 survivors suffering permanent physical and psychological disabilities. There are more than 3000 species of snakes around the world: 600 are venomous and over 200 are considered to be medically important because of their clinical effects. The severity of SBE depends on several factors among which bite localization, snake’s size, condition of glands and teeth, bite angle and bite duration, the microflora of the snake’s mouth and victim’s skin, age of the victim, weight, health status, and victim’s activity after a bite. Snake venoms are mixtures of protein families, and each of these families contains many different toxins or toxin isoforms. Based on their effects, snake venoms can be classified as hemotoxic, neurotoxic, or cytotoxic and they can all act together involving multiple tissues and organs. When the bite is fatal, the mechanism of death is primarily related to the paralysis of respiratory muscles, which causes asphyxia and hypoxic-ischemic encephalopathy, but also anaphylactic shock, hemorrhagic shock, cardiomyopathy, acute tubular necrosis (ATN). The purpose of this literature review is to evaluate epidemiological and post-mortem examination findings in fatal SBEs in order to better understand the pathophysiological mechanisms, thus helping pathologists in defining the correct diagnosis.

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“…Poisonous snakes are classified into neurotoxic, vasculotoxic and myotoxic. Out of neurotoxic and vasculotoxic snakes, Common Cobra & Russell's viper poisoning are more common [9]. So the efficacy of drug on common cobra venom and Russell's viper venom poisoning needs to be investigated [10].…”

Section: Introductionmentioning

confidence: 99%

In-vivo Study of the Efficacy of Sanjeevani Vati in Snake Venom Poisoining

Mohurle¹,

Lambat

2021

JPRI

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Background: Visha (Poison) is a substance, which after entering the body, disturbs natural and physiological functions of body (i.e. Dosha, Dhatu, Mala). Due to its potency, it may potentially cause death in a relatively short period. A significant proportion of Indians live in villages distant from the city and work in agriculture with their lower extremities exposed. Snake-rat habitat is more prevalent in rice and sugarcane fields. Aims and Objective: To study the efficacy of Sanjeevani Vati in common cobra venom poisoning and Russell’s viper venom as a first aid measure. Materials and Methods: The preparation of Sanjeevani Vatiis carried out in Department of Rasashastra, Govt. Ayurved College, Nagpur and venom was collected from snake farm’, Haffkine Institute for Training Research and Testing, Mumbai. Animal Experiment for efficacy of Sanjeevani Vati as a first aid measure on Common cobra venom and Russell’s viper venom was carried out in National Toxicology Center (NTC) Pune. Results: The results of survival period in Russell’s viper venom group were proved to be statistically significant. P value is 0.0055(Unpaired t-test; Two tail).But in results of Common Cobra venom, it was observed that there is no delay in appearance of paralysis, convulsion & survival period. In fact all these symptoms appear near about at same time, when Sanjeevani Vati was given orally after ingestion of Cobra Venom. Conclusion: Sanjeevani Vati property is an ophidian. If you have Russell's viper venom, it is helpful as a first aid measure since it extends its life time. Poly Valent Anti snake venom serum does not interact with it (PVASVS).

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Cardiac arrest and atrial fibrillation in a patient after hump-nosed pit viper (Hypnale hypnale) bite

Cited by 21 publications

References 19 publications

Acute ischemic stroke: a rare complication of hump-nosed pit viper (Hypnale spp.) bite: a case report

Acute ischemic stroke: a rare complication of hump-nosed pit viper (Hypnale spp.) bite: a case report

Snakebite Envenoming a Challenging Diagnosis for the Forensic Pathologist: A Systematic Review

In-vivo Study of the Efficacy of Sanjeevani Vati in Snake Venom Poisoining

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