Studies

G. blomhoffii, G. ussuriensis, G. intermedius (described as Agkistrodon blomhoffii, A. caliginosus, A. intermedius)
South Korea

Moore 1977: 48 Gloydius sp. bites; no identification at the species level; systemic signs of envenoming 23/48.
Sawai and Lah 1978: 82 Gloydius sp. bites; identification morphological: G. blomhoffii brevicaudis (A. blomhoffii brevicaudis) 12/48, G. ussuriensis (described as A. caliginosus) 13/82, G. saxatilis (A. saxatilis) 3/82; 54 unidentified.

G. blomhoffii (described as A. blomhoffii)
China
Anonymous 1974: 150 G. blomhoffii bites; no information regarding identification.

Signs & symptoms

Autopharmacological effects

G. blomhoffii, G. ussuriensis, G. intermedius
Vomiting 10/82, abdominal pain 6/82, diarrhoea 3/82 (Sawai and Lah 1978).

Local effects

G. blomhoffii, G. ussuriensis, G. intermedius

Local pain and swelling (23/23).

Local pain, swelling, blistering, subcutaneous haemorrhage, lymphadenopathy (Sawai and Lah 1978).

Necrosis (skin, subcutis, musculature, bones) 35/82. With tourniquets: necrosis 23/35, of whom 14/23 had deformities; without tourniquets: necrosis 12/35, of whom 2/12 had deformities; the tissue defects appear to be primarily a consequence of tourniquets (Sawai and Lah 1978).

G. blomhoffii

Local pain and swelling: mild 62/150, severe 88/150 (Anonymous 1974).

Neurological effects

G. blomhoffii, G. ussuriensis, G. intermedius

Diplopia 19/23, dysphagia, dysarthria 3/23 (Moore 1977).
Ptosis 6/82, blurred vision 9/82, dyspnoea 10/82 (Sawai and Lah 1978).

G. blomhoffii
Diplopia, dyspnoea 55/150; respiratory failure 33/150 (Anonymous 1974).

Renal effects

G. blomhoffii, G. ussuriensis, G. intermedius
Acute renal failure (secondary) 2/3 (Moore 1977).

G. blomhoffii

Acute renal failure (Anonymous 1974). Acute renal failure is the most common cause of death with bites from this species (Sawai 1989).

Other signs & symptoms

G. blomhoffii, G. ussuriensis, G. intermedius

Stiff neck 12/23; dark urine (myoglobinuria?) 10/23 (Moore 1977).

G. blomhoffii

Generalised muscle pain, stiff neck 88/150 (Anonymous 1974).

Morbidity

G. blomhoffii, G. ussuriensis, G. intermedius

Necrosis (skin, subcutis, musculature, bones) 35/82. With tourniquets: necrosis 23/35, of whom 14/23 had deformities; without tourniquets: necrosis 12/35, of whom 2/12 had deformities; total of 9 amputations (fingers, legs). The tissue defects appear to be primarily a consequence of tourniquets (Sawai and Lah 1978).

Case fatality rate

G. blomhoffii, G. ussuriensis, G. intermedius
1/23 (Moore 1977).
4/82; 4–9 days after the bite (Sawai and Lah 1978).

G. blomhoffii
17/150 (Anonymous 1974). Acute renal failure is the most common cause of death with bites from this species (Sawai 1989).

Laboratory and physical investigations

1. Haemostasis
Type of haemostatic defect

Fibrinogen-coagulating activity described, e.g. for G. ussuriensis (A. caliginosus) venom (clinical significance?) (Suzuki and Takahashi 1984).

Treatment (symptomatic)

Debridement 3/23 (Moore 1977).

Treatment (specific)

Antivenoms
Wyeth antivenin (Crotalidae), Philadelphia, USA

Efficacy

Efficacy of the Wyeth antivenom (Crotalidae) considered doubtful, as it is heterologous. Mamushi antivenom from Japan is recommended (Sawai and Lah 1978).