Sudden Death Following Hump-Nosed Pit Viper (Hypnale hypnale) Bite

Hump-nosed vipers of the genus Hypnale are venomous pit endemic to Sri Lanka and southwestern India. They most common cause snakebites in Lanka, causing 27 77% all snakebites.1Kasturiratne A. Wickremasinghe A.R. de Silva N. Gunawardena N.K. Pathmeswaran Premaratna R. et al.The global burden snakebite: a literature analysis modeling based on regional estimates envenoming deaths.PLoS Med. 2008; 5: e218Crossref PubMed Scopus (967) Google Scholar Usually, their bites local only.2Ariaratnam C.A. Thuraisingam V. Kularatne S.A.M. Sheriff M.H.R. Theakston R.D.G. al.Frequent potentially fatal by hump-nosed (Hypnale hypnale H. nepa) Lanka: lack effective antivenom.Trans R Soc Trop Med Hyg. 102: 1120-1126Abstract Full Text PDF (81) Less frequently, can significant morbidities, such as acute kidney injury, chronic disease,3Namal Rathnayaka R.M.M.K. Nishanthi Ranathunga P.E.A. Kidney injury following viper (Genus:Hypnale) proven probable cases.Trans 2019; 113: 131-142Crossref (11) venom-induced consumption coagulopathy,4Namal RMMK P.E.A.N. Venom-induced coagulopathy (Genus: Hypnale) uncertain efficacy fresh frozen plasma.Wilderness Environ 2020; 31: 131-143Abstract (3) wounds, amputations digits.2Ariaratnam Death after is very rare, mortality rate about 0.9 1%.2Ariaratnam Scholar,5Sellahewa K. Lessons from four studies management snake bite Lanka.Ceylon J. 1997; 42: 8-15PubMed When death does occur, it usually days bite. To our knowledge, sudden has not been previously reported We report case H which victim died approximately 45 min A 60-y-old male, diabetic estate worker was bitten while he working property situated 5 km away his house. He lived Nivithigala, remote village Ratnapura district, had gone own 3-wheeled vehicle at around 1000. The snakebite occurred left dorsum foot 1030. killed snake, came back home 1045, told story wife, identified Polon thelissa (the Sinhala name for viper). wife planned go nearby hospital 8 At that time, mild pain site few drops bleeding. While changing shirt, collapsed noted arm. carried 1115. did speak way hospital, upon arrival, declared dead admitting medical officer. brought man’s body transferred Teaching Hospital postmortem examination, along with offending snake. According standard key,6Maduwage Manamendra-Arachchi Pethiyagoda R.A. taxonomic revision South Asian (Squamata: Viperidae: Hypnale).Zootaxa. 2009; 2232: 1-28Crossref (39) (Figure 1) corresponding author. Autopsy examination showed pulmonary myocardial hemorrhage. Kidneys, liver, brain, coronary vessels were macroscopically normal. Acute renal tubular necrosis, ischemic damage hemorrhage observed microscopic 2).Figure 2Postmortem findings. A, Myocardial hemorrhages (indicated arrows). B, Pulmonary C, Histologic appearance necrosis ×40.View Large Image Figure ViewerDownload Hi-res image Download (PPT) Out 3 species Hypnale, deaths have hypnale7Namal Systemic bleeding including haemorrhage hypnale) envenoming: Lanka.Toxicon. 170: 21-28Crossref (6) Scholar,8Namal Ranaweera Jayasekara Cardiac arrest atrial fibrillation envenoming.Toxicon. 2018; 148: 33-39Crossref zara.9Maduwage Wazil Gawarammana I. Coagulopthy, zara first 2011; 58: 641-643Crossref (22) However, no so far regarding nepa envenomation. This because its rare. involving more than 1 system likely be fatal.7Namal Scholar, 8Namal 9Maduwage 10Kularatne Ratnatunga Severe systemic effects Merrem’s bite.Ceylon 1999; 44: 169-170PubMed In patient, although diabetic, detailed history confirmed good control regular treatments microvascular or macrovascular complications. Because patient admission resuscitation cardiac massage attempted. Circumstantial evidence suggests patient’s due venom. On there suggestive dysfunction arrhythmia rapid death. It possible may occur direct intravenous flow venom heart. however fang punctures. Currently, antivenom patients managed symptomatically. procoagulant contains thrombin-like enzymes complications intracranial hemorrhage.7Namal Pericardial endocardial cases bites.4Namal addition, arrest, fibrillation, changes electrocardiogram envenoming.8Namal Snake also vasospasm, thus ischemia myocardium.11Maheshwari M. Mittal S.R. infarction complicating snakebite.J Assoc Physicians 2004; 52: 63-64PubMed output reduced owing caused venom.12Aravanis C. Ioannidis P. Ktenas cerebrovascular accident young girl bite.Br Heart 1982; 47 (47:500–503)Crossref (42) other causes hyperkalemia vascular collapse, hypovolemic shock disruption cell membranes myofibrils. date, shortest duration 6 h facility,13Wijewantha H.S. Sellahewa K.H. Hump nosed - descriptive observational study 1543 cases.Asian Pac J 2010; 3: 902-905Crossref (13) this considering time since literature, anywhere between 16 d.7Namal Scholar,13Wijewantha Our however, before coming snakebite. Even if an available care hospitals, fatality still rapidly envenomation viper, highlighted presented.