horned viper bite
Bullae—serous, hemorrhagic, or both—usually appear at the bite site within 8 hours. Stopping trials early may result in insufficient evidence being accrued. The clinical picture is explicable by the presence in C. cerastes venom of several thrombin-like, Factor-X-activating, platelet-aggregating, haemorrhagic and nephrotoxic components. Tracheostomy may be needed if trismus, laryngeal spasm, or excessive salivation is present. About 25% of pit viper bites are dry (venom is not deposited), and no systemic symptoms or signs develop. Two hours after starting antivenom, his serum venom antigen concentration had dropped to 2.2 ng/ml. Most bites occur on the upper extremities. He had felt short of breath after walking up a slope to the hospital. A second dose of 10 ampoules of the same antivenom was therefore given 4 days after the bite. Five hours after starting antivenom, C. cerastes venom antigen was undetectable in his serum. Cottonmouth, copperhead, and pygmy rattlesnake envenomations may require smaller doses of antivenom. Twenty months after the snakebite, the patient was well with no sequelae. Lymphangitis and enlarged, tender regional lymph nodes may develop; temperature increases over the bite area. Patients with coagulopathy typically hemorrhage from the bite site or from venipuncture sites or mucous membranes, with epistaxis, gingival bleeding, hematemesis, hematochezia, hematuria, or a combination. In severe cases, hemolysis may cause a rapid fall in Hct. He felt well. There were two fang punctures on the knuckle of his right index finger and gross tender swelling of the entire right arm from fingers to the shoulder-tip. He was referred to the University Hospital of Zürich, arriving 8 h after the bite. Effects may include, Local tissue damage, causing edema and ecchymosis, A disseminated intravascular coagulation (DIC)–like (defibrination) syndrome, Pulmonary, cardiac, renal, and neurologic defects. A hornless subspecies C. c. mutila, inhabiting the western Sahara, was proposed by Doumergue.14 However, this feature is now regarded as merely a polymorphism and the subspecies is no longer recognized.15. Untreated, respiratory muscle paralysis may be fatal. This was about 48 h after heparin treatment had been stopped, but was temporally related to the administration of 0.25 mg of epinephrine subcutaneously as prophylaxis against an antivenom reaction.50 In Australia, there was an inconclusive debate about the role of epinephrine in haemorrhagic strokes complicating bites by tiger and brown snakes.51 Premawardhena et al. Venom alters capillary membrane permeability, causing extravasation of electrolytes, albumin, and red blood cells through vessel walls into the envenomated site. Last full review/revision Apr 2020| Content last modified Apr 2020. Because of the evidence of persistently increased fibrinolysis and the thrombocytopenia, it was decided to administer a second 100 ml dose of antivenom (Favirept, Pasteur Mérieux Lyon-France, fragments F(ab/)2 d’immunoglobulines équines antivenimeuses de Bitis, Echis, Naja, Cerastes et Macrovipera) on day 4, 80 h after the snakebite. There were blisters containing yellowish fluid and a hydrarthrosis of the knee. Allford SL, Rose P, Machin SJ. Background: The desert horned vipers (Cerastes cerastes and C. gasperettii) are the most familiar snakes of the great deserts of North Africa and the Middle East, including the plains of Iraq. Guidelines on the diagnosis and management of the thrombotic microangiopathic haemolytic anaemias. The snake caused a panic when worshippers saw it emerging from between the cracks of the ancient stones of the holy site. Copperheads and, to a lesser extent, cottonmouths account for most other venomous bites. Ecchymosis is most severe after bites by, Prairie, Pacific, and timber rattlesnakes. Werner YL, Leverdier A, Rosenman D, Sivan N. Systematics and zoo geography of Cerastes (Ophidia: Viperidae) in the Levant: 1. Subsequent antibiotic choices should be based on culture and sensitivity results from wound cultures. After consultation with DAW, 10 ampoules of Behringwerke Near and Middle East polyspecific antivenom were administered 23–24 h after the bite and, in view of his deteriorating renal function, he was admitted to the Renal Unit. This was also the case in victims of Russell's viper (Daboia siamensis) bite in Myanmar, even when antivenom was administered within 1–2 h of envenoming.48. D-dimers were slightly elevated (Table 1). Marrakchi N, Barbouche R, Guermazi S, Bon C, el Ayeb M. Procoagulant and platelet-aggregating properties of cerastocytin from Cerastes cerastes venom. Renal alterations induced by Cerastes cerastes cerastes venom. Treatment begins immediately, before patients are moved to a medical facility. Shah NT, Rand JH. Haematemesis was recorded in one and haematuria in four cases. Shargil A, Shabaton D, Rosenthal T. Clinical and laboratory findings in Aspis cerastes snake bite. Results: Two men bitten while handling captive Saharan horned vipers (Cerastes cerastes) in Europe developed extensive local swelling and life-threatening systemic envenoming, characterized by coagulopathy, increased fibrinolysis, thrombocytopenia, micro-angiopathic haemolytic anaemia and acute renal failure. Laidlaw, A.M. El Nahas, R.D.G. Will we listen to anger, like Cain? He was given haemodialysis 4, 6 and 11 days after the bite. We attempt to attribute the underlying pathophysiological mechanisms to known constituents of the venom of this fabulous snake. Identification is facilitated by the distinctive supraorbital ‘horns’ (Figure 1), which make this snake virtually unmistakable. Five and a half hours after the bite, an area of necrosis 1.5 cm in diameter was discernible at the bite, and there was evidence of coagulopathy: International Normalized Ratio (INR) 2.4, PTT 67 s, fibrinogen 0.3 g/l. It is attributable to vascular endothelial damage and thrombin deposition on the walls of blood vessels, resulting in the distortion, damage and destruction of circulating erythrocytes. Measuring up to 5 feet, the Palestine Viper is responsible for an overwhelming majority of venomous snake bites in Israel, which has 42 species of snakes including nine venomous ones. He remained haemodynamically stable, but was virtually anuric. A number of cases of C. cerastes envenoming have been described in Israel. Dissanayake AS, Karunanayake P, Kasturiratne KTAA, et al. Pressure immobilization to delay systemic absorption of venom (eg, by wrapping wide crepe or other fabric bandages around the limb) may be appropriate for coral snake bites but is not recommended in the US, where most bites are from pit vipers; pressure immobilization may cause arterial insufficiency and necrosis.

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