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Clinic

 

Thelotornis capensis, Thelotornis kirtlandii

Case reports

Thelotornis kirtlandii

FitzSimons and Smith 1958, Beiran and Currie 1967, Mebs et al. 1978, Visser and Chapman 1978, Blaylock 1960, Broadley 1957

 

Thelotornis capensis

Atkinson et al. 1980, Saddler and Paul 1988

Signs & symptoms

Local effects

Local swelling which may extend to adjacent areas of the affected extremity.

Haemostatic effects

Bleeding from superficial wounds, even those which had already healed; gingival bleeding, epistaxis, haematemesis, bleeding per rectum, haematuria, intracranial bleeding.

Renal effects

Acute kidney failure (secondary to DIC).

Morbidity

Anaemia, kidney failure.

Case fatality rate

1/1 Intracranial bleeding (and bleeding into the pericardium, pleura, retroperitoneum, stomach and both kidneys) (FitzSimons and Smith 1958).
1/1 Intracranial bleeding (and bleeding from virtually all mucous membranes) (Mebs et al. 1978). 

Laboratory and physical investigations

Haemostasis

Type of haemostatic defect:
Probably similar to Dispholidus typus envenoming (Minton 1990b).

 

Overview haemostasis
   
A
 
    
B
 
B
 
                            
 
 H CT (FSP) Tc PT aPTT TT I FSP D II V VIII X XIII PC ATIII PI tPA α2AP
               
 
C
                        
 

Essential

bed-side

tests

 Tests for full clinical assessment Tests for research purposes
H haemorhagic effects
+ definite evidence in
human envenoming
CT full blood clotting test
(FSP)  FSP rapid test
Tc platlets
PT prothrombin time
aPTT partial thromboplastin time
TT thrombin time
I fibrinogen
FSP  fibrinogen split products
D D-dimer
II, V, VII, X, XIII
  clotting factors
PC protein C
ATIII antithrombin III
PI plasminogen
tPA tissue plasmin activator
α2AP α2-antiplasmin
 
In this overview, the deviations from normal
are recorded for those haemostasis para-
meters only, for which good evidence is
documented in the literature.
  
A CT: increased (Saddler and Paul 1988).
B PT, aPTT: increased (Saddler and Paul 1988).
C

Fibrinogen: afibrinogenaemia (Mebs et al. 1978).

Treatment (symptomatic)

  1. Blood transfusions,
  2. Clotting factor and platelet replacement,
  3. Dialysis.

Treatment (specific)

Antivenom: no antivenom available, no known paraspecific neutralization.