Hyponatraemia and seizures in Merrem’s hump-nosed pit viper (Hypnale hypnale) envenoming: a case report

Silva, Umesh de; Sarathchandra, Chamara; Senanayake, Hemal; Pilapitiya, Senaka; Siribaddana, Sisira; Silva, Anjana

doi:10.1186/s13256-018-1756-2

Cited by 9 publications

(4 citation statements)

References 9 publications

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“…There is a case report on a patient developing thrombotic thrombocytopenic purpura with a coma five days after envenomation by a HNV [12]. Seizures due to hyponatremia a day after a HNV bite were recently reported [13]. However, the serum sodium level of our patient went below 135 mmol/l (130 mmol/l) only once in day 4.…”

Section: Discussionmentioning

confidence: 61%

An Atypical Clinical Manifestation of a Hump-Nosed Pit Viper Envenomation

Ehelepola

Karunathilaka

Liyanage

et al. 2019

Case Reports in Medicine

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Envenomations by hump-nosed pit vipers (HNVs) are frequent in Sri Lanka and in South India. Until recently, HNV was considered a moderately venomous snake. Here, we report a case of a previously healthy female developing all the known serious complications, plus some previously unreported complications following a HNV envenomation. She had muscarinic symptoms like profuse sweating and salivation within a couple of minutes and a seizure several minutes after envenomation. Her acute kidney injury (AKI) was swift onset and progressed to end-stage renal failure at three months. She had mild parotid swelling, crepitations in her lungs, and edema of the bitten leg. She had evidence of microangiopathic hemolytic anemia and hemolytic uremic syndrome as well. She developed local tissue necrosis, a non-ST-elevation myocardial infarction (non-STEMI), and anterior ischemic optic neuropathy (AION) following the envenomation. We believe the best explanation for her swift onset complication is intravascular injection of venom. We believe ischemia due to thrombotic microangiopathy has contributed to local tissue necrosis. Those ischemia and kidney failure have contributed to non-STEMI and AION. We illustrate the issue of the sluggish progress made by medicine in understanding the complications of envenomation by using HNV as an example.

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Section: Discussionmentioning

confidence: 61%

An Atypical Clinical Manifestation of a Hump-Nosed Pit Viper Envenomation

Ehelepola

Karunathilaka

Liyanage

et al. 2019

Case Reports in Medicine

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“…Other known complications associated with H hypnale bites include ischemic and hemorrhagic stroke, acute coronary syndrome and toxic myocarditis, atrial fibrillation, and seizures. 14,[20][21][22] None of the 3 patients responded to Indian polyvalent ASV. ASV is often administered because of a delay in the identification of the species (as in Case 3).…”

Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Hump-Nosed Pit Viper Envenomation in Western Coastal India: A Case Series

Sirur

Balakrishnan

Lath

2022

Wilderness & Environmental Medicine

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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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“…Hyponatremia has also been described after envenoming from viperids, with reported cases following bites by the berg adder (Bitis Atropos), endemic to South Africa, and the humpnosed pit viper (Hypnale hypnale) from Sri Lanka. 68,69 In a series of berg adder bite victims, hyponatremia was documented in eight of nine patients. The lowest documented sodium was 111 mmol/L, and hyponatremia occurred after 18-48 hours of envenoming, similar to the temporal profile of krait bite-induced hyponatremia.…”

Section: Tablementioning

confidence: 99%

Endocrine and Metabolic Manifestations of Snakebite Envenoming

Bhattacharya

Gopalakrishnan

Kalra

et al. 2020

The American Journal of Tropical Medicine and Hygiene

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Snakebite envenoming is a neglected, public health problem in tropical and subtropical regions. Local tissue necrosis, neurotoxic, and hemo-vasculotoxic effects are well-recognized features, whereas the endocrine and metabolic derangements are not as well known. In addition to contributing to morbidity, some of these manifestations can be potentially life-threatening if not recognized early. The most prominent endocrine manifestation is hypopituitarism (HP), which can manifest acutely or remain asymptomatic and present years later. Unexplained recurrent hypoglycemia and refractory hypotension are early clinical clues to suspect corticotroph axis involvement in acute settings. Chronic pituitary failure may present, like Sheehan's syndrome, several years after the bite. The occurrence of acute kidney injury, capillary leak syndrome, and disseminated intravascular coagulation are predictors of HP. Adrenal hemorrhages are documented in autopsy series; however, primary adrenal insufficiency is very rare and confounded by the presence of HP. Hyponatremia, hypokalemia or hyperkalemia, and dysglycemia can occur, but the mechanisms involved are only partially understood. Awareness, a high index of suspicion, correct interpretation of hormonal parameters, and timely treatment of these abnormalities can be lifesaving.

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Hyponatraemia and seizures in Merrem’s hump-nosed pit viper (Hypnale hypnale) envenoming: a case report

Cited by 9 publications

References 9 publications

An Atypical Clinical Manifestation of a Hump-Nosed Pit Viper Envenomation

An Atypical Clinical Manifestation of a Hump-Nosed Pit Viper Envenomation

Hump-Nosed Pit Viper Envenomation in Western Coastal India: A Case Series

Endocrine and Metabolic Manifestations of Snakebite Envenoming

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