title: Type IV renal tubular acidosis following resolution of acute kidney injury and disseminated intravascular coagulation due to hump-nosed viper bite.
abstract: Hump-nosed viper bite can cause acute kidney injury (AKI) and disseminated intravascular coagulation. In some patients, it can cause chronic kidney disease necessitating life-long renal replacement therapy. Lack of effective antivenom makes the management of these patients difficult. A 51-year-old Sri Lankan male was admitted with AKI and disseminated intravascular coagulation following a hump-nosed viper bite. He made a complete recovery with blood product support and hemodialysis. Renal biopsy was performed as his renal recovery was prolonged which revealed patchy tubular atrophy and interstitial inflammation suggestive of subacute interstitial nephritis. Later, he presented with hyperkalemic paralysis and acidosis. A diagnosis of late onset type 4 renal tubular acidosis was made and he responded well to a course of fludrocortisone.
authors: Department of Clinical Medicine, National Hospital, Colombo, Sri Lanka.
authors: S
authors: S
authors: Karunarathne
authors: Y
authors: Y
authors: Udayakumara
authors: D
authors: D
authors: Govindapala
authors: H
authors: H
authors: Fernando
keywords: Snake bite; acute kidney injury; renal tubular acidosis
references: Ceylon Med J. 1983 Sep;28(3):144-54
references: 6386199
references: J Am Soc Nephrol. 2009 Feb;20(2):251-4
references: 19193780
references: Postgrad Med J. 1970 Jul;46(537):449-51
references: 5476148
references: Ceylon Med J. 1983 Sep;28(3):163-9
references: 6679805
references: Nephrol Dial Transplant. 1987;2(4):219-23
references: 3118260
references: Ceylon Med J. 1999 Dec;44(4):169-70
references: 10895268
references: Trans R Soc Trop Med Hyg. 2008 Nov;102(11):1120-6
references: 18455743
references: Am J Trop Med Hyg. 1998 Jun;58(6):821-3
references: 9660472
references: Am J Physiol. 1976 Feb;230(2):410-8
references: 1259022
references: Trans R Soc Trop Med Hyg. 1994 Mar-Apr;88(2):209-12
references: 8036678
references: Trans R Soc Trop Med Hyg. 1996 May-Jun;90(3):293
references: 8758082