title: Acute pituitary insufficiency and hypokalaemia following envenoming by Russell's viper (Daboia russelii) in Sri Lanka: Exploring the pathophysiological mechanisms.
abstract: Russell's viper envenoming is associated with a high incidence of morbidity and mortality. Hypopituitarism following envenoming by Russell's vipers is a well recognized sequel in Burma and parts of India but has been reported only once in Sri Lanka. Hypokalaemia following envenoming by Russell's viper has not been described. Here we describe the association of acute pituitary insufficiency and hypokalaemia following Russell's viper envenoming in Sri Lanka and review the literature in order to understand its pathophysiological basis. A previously healthy 21-year-old man was envenomed by a Russell's viper and treated with antivenom. Ten hours after the bite, he developed persistent hypotension, which responded promptly to intravenous dexamethasone. His hormone profiles were consistent with hypocortisolism secondary to acute pituitary insufficiency. He also developed hypokalaemia. Analysis of urine and serum electrolytes suggested redistribution of potassium in to the cells rather than renal loss. Hypotension and hypoglycaemic coma are life-threatening manifestations of acute pituitary insufficiency. Therefore prompt steroid administration in these setting is life saving. Awareness of these complications among physicians would help to make prompt diagnosis and initiate immediate life saving treatment.
authors.affiliation: University Medical Unit, National Hospital of Sri Lanka, Colombo, Sri Lanka.
authors.forename: Vijayabala
authors.initials: V
authors.lastname: Jeevagan
authors.forename: Prasad
authors.initials: P
authors.lastname: Katulanda
authors.forename: Christeine Ariaranee
authors.initials: CA
authors.lastname: Gnanathasan
authors.forename: David A
authors.initials: DA
authors.lastname: Warrell
mesh_terms: D000208:Acute Disease; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007008:Hypokalemia / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D007018:Hypopituitarism / Q000139:chemically induced* / Q000503:physiopathology / Q000628:therapy; D007022:Hypotension / Q000139:chemically induced / Q000628:therapy; D008297:Male; D017840:Daboia; D012909:Snake Bites / Q000150:complications* / Q000503:physiopathology / Q000628:therapy; D013188:Sri Lanka; D016896:Treatment Outcome; D014757:Viper Venoms / Q000506:poisoning*; D055815:Young Adult
chemical_list: D000997:Antivenins; D005938:Glucocorticoids; D014757:Viper Venoms; D003907:Dexamethasone