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Abstract
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Hump-nosed vipers of the genus Hypnale are venomous pit vipers endemic to Sri Lanka and southwestern India. They are the most common cause of venomous snakebites in Sri Lanka, causing 27 to 77% of all snakebites.
Usually, their bites cause local envenoming only. Less frequently, bites can cause significant morbidities, such as acute kidney injury, chronic kidney disease, venom-induced consumption coagulopathy, chronic wounds, and amputations of digits. Death after hump-nosed viper bites is very rare, and the mortality rate is about 0.9 to 1%. When death does occur, it is usually in the days after the bite. To our knowledge, sudden death has not been previously reported after a hump-nosed viper bite. We report a fatal case of proven H hypnale bite in which the victim died approximately 45 min after the bite.
A 60-y-old male, diabetic estate worker was bitten by a hump-nosed viper while he was working on property situated about 5 km away from his house. He lived in Nivithigala, a remote village in the Ratnapura district, and had gone to the estate in his own 3-wheeled vehicle at around 1000. The snakebite occurred on the left dorsum of his foot at around 1030. He killed the snake, came back home by his vehicle at around 1045, told the story to his wife, and identified the snake as a Polon thelissa (the Sinhala name for hump-nosed pit viper). He and his wife planned to go to a nearby local hospital situated about 8 km from their house. At that time, he had mild pain at the site of bite and few drops of bleeding. While he was changing his shirt, he collapsed and noted pain in his left arm. He was carried to the local hospital at about 1115. He did not speak on the way to the hospital, and upon arrival, he was declared dead by the admitting medical officer. The snake, which was brought to the local hospital, was identified as a hump-nosed viper by the admitting medical officer. The man's body was transferred to Teaching Hospital Ratnapura for postmortem examination, along with the offending snake. According to the standard key, the snake was identified as H hypnale (Figure 1) by the corresponding author. Autopsy examination showed pulmonary and myocardial hemorrhage. Kidneys, liver, brain, and coronary vessels were macroscopically normal. Acute renal tubular necrosis, acute ischemic damage to the brain, and pulmonary hemorrhage were observed on microscopic examination...
Language: en |