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Viperidae Envenomation in India

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Clinical Toxinology in Asia Pacific and Africa

Part of the book series: Toxinology ((TOXI,volume 2))

Abstract

The estimated incidence of venomous snakebites in India is around 300,000 annually and the overall mortality is between 30,000 and 50,000. The majority of this is due to Viperidae envenomation. There is a lack of consensus regarding the management protocol. The symptoms, signs, diagnosis, and management of Viperidae envenomation are discussed. Well-known signs are due to hemorrhages and local reaction. Rare signs include bilateral parotid swellings, hypopituitarism, and capillary leak. A standard protocol for diagnosis and management is evolved in the light of treating a large number of Viperidae bites. Twenty minute whole blood clotting test (WBCT) is the gold standard for the diagnosis of Viperidae envenomation. When 20 min WBCT is positive, treatment is initiated with 10 vials of anti-snake venom [ASV], which is delivered in 100 ml of normal saline in 1 h. The repeat dose of ASV is given after 6 h if the 20 min WBCT is prolonged at 6 h after the first dose. Supportive treatment includes fresh frozen plasma and platelet transfusion. Antibiotics and tetanus immunization are given in all cases. The causes of mortality are bleeding into the lungs and brain, renal failure, intractable hypotension due to capillary leak syndrome, and hypotension due to unexplained etiology. Signs of recovery after ASV and bad prognostic signs are discussed.

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Author information

Authors and Affiliations

  1. Little Flower Hospital and Research Centre, 683572, Angamaly, Kerala, India

    Joseph K. Joseph

Authors
  1. Joseph K. Joseph
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Correspondence to Joseph K. Joseph .

Editor information

Editors and Affiliations

  1. Venom and Toxin Research Programme Department of Anatomy, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore

    P. Gopalakrishnakone

  2. Professor of Medicine (Rtd), Sir Salimullah Medical College, Dhaka, Bangladesh

    Abul Faiz

  3. Department of Forensic Medicine and Toxicology, University of Colombo, Colombo, Sri Lanka

    Ravindra Fernando

  4. Department of Clinical Medicine Faculty of Medicine, University of Colombo, Colombo, Sri Lanka

    Christeine Ariaranee Gnanathasan

  5. Infectious and Tropical Diseases Unit Department of Medicine, Bayero University Kano Aminu Kano Teaching Hospital, Kano, Nigeria

    Abdulrazaq Garba Habib

  6. Department of Medicine, School of Medicine National Yang-Ming University, Taipei, Taiwan

    Chen-Chang Yang

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Joseph, J.K. (2015). Viperidae Envenomation in India. In: Gopalakrishnakone, P., Faiz, A., Fernando, R., Gnanathasan, C., Habib, A., Yang, CC. (eds) Clinical Toxinology in Asia Pacific and Africa. Toxinology, vol 2. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-6386-9_40

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