title: Severe systemic effects of Merrem's hump-nosed viper bite.
abstract: OBJECTIVE
  To report unpredictable severe systemic effects of hump-nosed viper envenomation.
  
  
  METHODS
  Medical unit, General hospital, Anuradhapura.
  
  
  METHODS
  The clinical outcome of seven patients bitten by Merrem's hump-nosed viper were monitored until recovery or death. Limited autopsies were performed on the latter. Offending snakes were positively identified by medical officers and in one instance by a herpetologist.
  
  
  CONCLUSIONS
  Merrem's hump-nosed viper bites, caused an array of potentially fatal systemic manifestations. One patient developed neurological effects, severe Raynaud's syndrome leading to ascending gangrene of distal limbs and adult repiratory distress syndrome (ARDS), in addition to the known complications of severe renal cortical necrosis and haemostatic dysfunction. Two patients who developed acute renal failure and prolonged coagulopathy recovered completely. The combination of extensive renal cortical necrosis, disseminated intravascular coagulation, and ARDS proved fatal in three.
authors.affiliation: General Hospital, Anuradhapura.
authors.forename: S A
authors.initials: SA
authors.lastname: Kularatne
authors.forename: N
authors.initials: N
authors.lastname: Ratnatunga
mesh_terms: D058186:Acute Kidney Injury / Q000209:etiology*; D000328:Adult; D000818:Animals; D000997:Antivenins / Q000494:pharmacology; D004211:Disseminated Intravascular Coagulation / Q000209:etiology*; D017809:Fatal Outcome; D006801:Humans; D011379:Prognosis; D011928:Raynaud Disease / Q000209:etiology*; D012128:Respiratory Distress Syndrome / Q000209:etiology*; D012909:Snake Bites / Q000097:blood / Q000150:complications* / Q000628:therapy; D016019:Survival Analysis; D017819:Viperidae
chemical_list: D000997:Antivenins