Hump-nosed Pit Viper Bite in Sri Lanka?Unravelling an Enigma

Sellahewa, Kolitha H.

doi:10.4172/2329-891x.1000114

Cited by 4 publications

(18 citation statements)

References 28 publications

(42 reference statements)

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“…The role of FFP and haemodialysis in HNV envenomation is worth studying in randomised double-blind controlled clinical trials. 3,5 In our patient, MAHA and thrombocytopenia were settled with repeated blood and FFP transfusions and his renal functions were back to normal limits after 2 weeks of renal replacement therapy. Ultrasound scan showed early renal parenchyma disease.…”

Section: Discussionmentioning

confidence: 56%

“…7 The key clinical features in this favouring HNV bite are local envenoming, non-coagulable blood and renal failure. 3,4,8 Fang marks are invariably found after HNV bite. Typical local envenomation, skin and soft tissue swelling, necrosis and systemic envenomation are suggestive of HNV bite in our patient.…”

Section: Discussionmentioning

confidence: 99%

“…1 In a prospective study of snakebites involving 10 hospitals in Sri Lanka, 302 (35%) of 860 patients with bites by identified snakes proved to have been bitten by hump-nosed pit vipers. 2 It has now been established that HNVs are highly venomous and the clinical presentation ranges from local swelling and necrosis at the bite site with distinct fang marks to systemic envenomation leading to coagulopathy, thrombotic microangiopathy (TMA), acute kidney injury and death in severe cases [3][4][5] Here, we present a case of delayed presentation to medical care with HNV 'Hypnale' bite.…”

Section: Introductionmentioning

confidence: 99%

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Thrombotic microangiopathy following hump-nosed viper ‘Hypnale’ envenomation

Puthra

Pirasath

Sugathapala

et al. 2020

SAGE Open Medical Case Reports

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The hump-nosed vipers which compromise ‘ Hypnale hypnale’, ‘H. zara’ and ‘H. nepa’ have been highly venomous snakes and ‘H. zara’ and ‘H. nepa’ are indigenous to Sri Lanka and ‘H. hypnale’ is endemic to Sri Lanka and India. The clinical presentations range from local swelling, blistering and necrosis at the site of bite with distinct fang marks to systemic envenomations such as coagulopathy, thrombotic microangiopathy, acute kidney injury and death in severe cases. Here, we report a case of thrombotic microangiopathy following hump-nosed viper ‘ Hypnale’ bite.

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Section: Discussionmentioning

confidence: 56%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Thrombotic microangiopathy following hump-nosed viper ‘Hypnale’ envenomation

Puthra

Pirasath

Sugathapala

et al. 2020

SAGE Open Medical Case Reports

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“…The commonest cause of snake bite envenoming in Sri Lanka is due to the hump-nosed viper [1,2]. Three species of HNV of the genus Hypnale are found in Sri Lanka; Hypnale hypnale, H. nepa and H. zara [4].…”

Section: Discussionmentioning

confidence: 99%

“…Hump-nosed viper (HNV) bite is one of the medically important envenomation in the Indian subcontinent which causes significant morbidity and mortality [1]. It can cause a variety of clinical manifestations such as local inflammation, blistering and systemic envenomation such as haematological manifestations and acute kidney injury [2].…”

Section: Introductionmentioning

confidence: 99%

A life-threatening complication due to pulmonary haemorrhage following hump-nosed viper bite

2020

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Background: Hump-nosed viper bite, the commonest venomous snake bite in Sri Lanka, is associated with significant morbidity. Specific anti-venom is not available for hump-nosed viper envenomation which is usually managed with supportive treatment. Pulmonary haemorrhage is an unusual manifestation of hump-nosed viper bite. Here we present a case of hump-nosed viper envenomation which complicated by pulmonary haemorrhage and was successfully treated with systemic steroids. To the best of our knowledge, it has not been reported in the literature before.Case presentation: A previously healthy 55-year-old man presented to the local hospital 18 h after a hump-nosed viper bite. He developed bilateral severe pulmonary haemorrhages, evidenced by rapid desaturation which needed intubation and mechanical ventilation, bleeding from the endotracheal tube and bilateral alveolar shadows in a chest x-ray. He had no other bleeding manifestations. Because of the life-threatening situation, he was treated with methylprednisolone pulse therapy. There was a rapid improvement of hypoxia with a resolution of x-ray changes. He was successfully weaned off from the ventilation after 24 h. Conclusion: This case highlights the importance of suspecting pulmonary haemorrhage in a patient who develops desaturation and alveolar shadow following hump-nosed viper bite even in the absence of other bleeding manifestation. Early and timely treatment with systemic steroid can be lifesaving in such patients.

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The use of rotational thromboelastometry parameters in understanding the coagulopathy following hump-nosed viper (Hypnale spp) bites: a preliminary study

Alvitigala

Gooneratne

Dharmasena³

et al. 2023

Trop Dis Travel Med Vaccines

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Background Hump-nosed vipers (HNV; Hypnale spp) are one of the medically important venomous snakes in Sri Lanka and South-Western regions of India. The haemostatic dysfunction due to HNV bites is poorly characterized by standard diagnostic tests performed to identify coagulopathy. We aimed to determine the usefulness of rotational thromboelastometry (ROTEM) parameters compared to 20-minute whole blood clotting test (WBCT20) and prothrombin time (PT) in understanding the coagulopathy of HNV bites. Methods Twenty-three HNV snakebite patients in a prospective study of 127 consecutive snakebites were recruited. After recording details of the clinical presentation, PT/international normalized ratio (INR), WBCT20 and ROTEM delta were performed at presentation. Results In this preliminary study, none of the patients had clinically apparent bleeding. Coagulopathy was detected by either WBCT20, INR or ROTEM in 13 HNV patients. Eleven had a coagulopathy detectable by ROTEM (either abnormal EXTEM-CT, INTEM-CT or FIBTEM-MCF) but with negative WBCT20. Of them, only two had prolonged INR values. Two patients had positive WBCT20 but with normal ROTEM and INR values. The remaining 10 patients did not show any coagulopathy either by INR, ROTEM or WBCT20. Conclusion In this preliminary study with small number of sample size, ROTEM parameters appeared to be more sensitive to subtle changes in coagulation compared to WBCT20. The clinical utility of detecting these changes and their usefulness in managing snakebite should be explored further in a larger study.

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Hump-nosed Pit Viper Bite in Sri Lanka?Unravelling an Enigma

Cited by 4 publications

References 28 publications

Thrombotic microangiopathy following hump-nosed viper ‘Hypnale’ envenomation

Thrombotic microangiopathy following hump-nosed viper ‘Hypnale’ envenomation

A life-threatening complication due to pulmonary haemorrhage following hump-nosed viper bite

The use of rotational thromboelastometry parameters in understanding the coagulopathy following hump-nosed viper (Hypnale spp) bites: a preliminary study

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