Case reports

Sri Lanka
De Silva 1988: 1 Hypnale hypnale bite; identification: morphological.
De Silva et al. 1994: 1 Hypnale hypnale bite; identification: morphological.

Signs & symptoms

Local effects

Local pain, local swelling (De Silva 1988, De Silva et al. 1994).

Haemostatic effects

Gastrointestinal bleeding, anaemia (De Silva et al. 1994).

Renal effects

Clinical signs of acute renal failure (De Silva et al. 1994).

Morbidity

Acute renal failure (De Silva et al. 1994).

Laboratory and physical investigations

1. Haemostasis
Type of haemostatic defect

Weak, direct fibrinogen-coagulating and weak fibrinolytic activity and platelet-aggregating activity (De Silva et al. 1994).

2. Haemoglobin
Minimum 7.4 mg/dl (De Silva et al. 1994).

3. Serum urea
Maximum 36.6 mmol/l (De Silva et al. 1994).

4. Serum potassium
Maximum 6.4 mmol/l in the context of acute renal failure (De Silva et al. 1994).

Treatment (symptomatic)

1. Peritoneal dialysis (De Silva et al. 1994).
2. Blood transfusion (De Silva et al. 1994).

Treatment (specific)

Antivenom
Polyvalent antisnake venom serum, Haffkine, Bombay, India.

Indications for antivenom
Incoagulable blood (De Silva et al. 1994).

Dose
5 vials (De Silva et al. 1994).

Efficacy

With regard to the haemostatic defect: no effect. The coagulation disorder persisted for approx. 1 week (De Silva et al. 1994).

Evaluation and recommendations

Polyvalent antisnake venom serum, Haffkine, Bombay, India, is ineffective in envenoming due to Hypnale hypnale. This is not surprising, as venom from this species is not used in the production of this antivenom. Because of the regional significance of Hypnale hypnale bites, production of a specific antivenom is recommended (De Silva et al. 1994).