title: Revisiting saw-scaled viper (Echis carinatus) bites in the Jaffna Peninsula of Sri Lanka: distribution, epidemiology and clinical manifestations.
abstract: In Sri Lanka, the saw-scaled viper (Echis carinatus) is distributed in the arid, dry and sandy coastal plains and in a prospective study we describe its bites in the Jaffna peninsula. Of the 304 snake bite admissions to the Jaffna Hospital in 2009, 217 (71.4%) were bitten by either venomous species or envenomed by unidentified snakes. There were 99 (45.6%) reported saw-scaled viper bites, of which 26 were confirmed cases. The length of the offending snakes ranged from 228-310mm and bites mainly occurred in the nearby islands. The median age of the confirmed cases was 34 years (range 1.5-72 years); occupations included housewives (8, 31%), school children (4, 15%) and farmers (2, 8%). In 18 patients (69%), bites occurred in daylight and in 8 (31%) within or near the compounds. The fingers were bitten in 8 (31%) and toes/foot in 11 (42%) cases. There were 2 (8%) dry bites and 19 patients (73%) developed local swelling; one patient developed haemorrhagic blisters. In 24 patients (92%), blood incoagulability manifested between 40 and 1095min after the bite, and three patients (12%) developed spontaneous bleeding. One patient (4%) developed mild acute renal dysfunction. The median time for correction of coagulopathy was 802min (range 180-1669min) with Indian polyvalent antivenom. All recovered. The saw scaled viper is responsible for most venomous bites in the Jaffna peninsula.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of Peradeniya, Kandy, Sri Lanka. samkul@sltnet.lk
authors.forename: S A M
authors.initials: SA
authors.lastname: Kularatne
authors.forename: S
authors.initials: S
authors.lastname: Sivansuthan
authors.forename: S C
authors.initials: SC
authors.lastname: Medagedara
authors.forename: K
authors.initials: K
authors.lastname: Maduwage
authors.forename: A
authors.initials: A
authors.lastname: de Silva
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage; D001778:Blood Coagulation Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012909:Snake Bites / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D012911:Snakes; D013045:Species Specificity; D013188:Sri Lanka / Q000453:epidemiology; D014757:Viper Venoms / Q000506:poisoning*; D055815:Young Adult
chemical_list: D000997:Antivenins; D014757:Viper Venoms