Clinical Flowchart
Autopharmacological effects
| Vipera sp. |
| Nausea, vomiting, abdominal pain, diarrhoea
(urticaria, angio-oedema) (bronchospasm) arterial hypotension |
| Cardiovascular failure1 |
| 1 | If the patient goes into shock, it can be within 5 minutes (Warrell 2005), but there can be a longer latency period, and the signs and symptomsmay persist or fluctuate for as long as 48 hours in the absence of treatment. (Warrell 2005, Reid 1976). |
Local effects
| Vipera sp. |
| Minutes (to hours)1 |
| Local pain and swelling1 |
| Painful swelling of the regional lymph nodes |
| Extensive swelling (ecchymoses) |
| Hypovolaemia |
| 1 | Oedema occurred in 82/102 prospectively studied bites (V. berus, V. aspis). In all 82 patients the oedema occurred within the first 2 h. All patients who developed no oedema or only local oedema also had no systemic signs of envenoming and had venom levels in blood/serum and urine that were no different from those in the control group (individuals not bitten). The extent of the oedema (regional oedema = majority of the bitten extremity affected, and extensive oedema = regional oedema and trunk affected) was a good indicator of systemic envenoming: sensitivity 100%, specificity 85%, positive predictive value 65%, negative predictive value 100% (Audebert et al. 1992). |
Haematological effects
Systemic bleeding is rare even in cases of systemic envenoming1, see clinical entries.
| 1 | Systemic bleeding (Gerrard and Pugh 1982) is the exception even in cases of severe envenoming (Reid 1976).
Clinical features of a bleeding diathesis are unusual, but bleeding from the gums and nose and into the lungs, gastrointestinal and genitourinary tracts, and serosal cavities and retroperitoneally can occur (Warrell 2005). |
Neurological effects
In bites by V. berus, V. ammodytes and in particular V. aspis geographically restricted1. See clinical entries.
| 1 | Cases of envenoming due to V. aspis with neurological signs (predominately cranial nerve deficits, such as facial diplegia, pharyngo-laryngeal paralysis, bilateral ptosis and external ophthalmoplegia, dysphonia, dysphagia, but also dyspnoea) have been described in Italy (Antonini et al. 1991, Beer and Putorti 1998, Re et al 1999) and in South-Eastern France (de Haro et al 2002). |
Muscular effects
Not observed.
Cardiac effects
| Vipera sp. |
| ? |
| Myocardial injury1 |
| 1 | Myocardial injury in connection with envenoming due to European vipers has been reported. |
Renal effects
Secondary to arterial hypotension / shock.