Hump-nosed Pit Viper Bite in Sri Lanka?Unravelling an Enigma

Abstract

Lack of detailed studies on hump-nosed viper apart for a few isolated case reports had left a void of knowledge for centuries. Consequently, its precise clinical features and management remained an enigma. Detailed clinical studies initiated by me in 1990 and escalated by other investigators in the recent past have accurately identified the different species of Hypnale, and species specific clinical features. Coagulopathy and acute kidney injury (AKI), though rare, are the most important and potentially fatal systemic effects. The lack of efficacy and safety of the currently available antivenom is now well recognised. While haemodialysis can salvage patients developing AKI, use of fresh frozen plasma is an exciting management option to prevent AKI, when used early for selected patients at the inception of coagulopathy. An attempt to develop species specific safe and efficacious antivenom with international collaboration has been initiated.