Canis ISSN: 2398-2942

Adder bite poisoning

Synonym(s): Snake bite

Contributor(s): Glen Cousquer

Introduction

  • The adder, or viper (Vipera berus ), is the only venomous snake in UK.
  • Snake bite envenomation occurs in approximately 50% of bites.
  • Cases of envenomation generally occur between February and October, peaking in June to August, and should always be treated as an emergency.
  • Adder bites can be life-threatening where systemic envenoming occurs.
Print off the owner factsheet Adder bites in dogs to give to your client.

Pathogenesis

Etiology

  • Venom constituents are complex, containing a mixture of enzymes, proteins and peptides. Furher details on the enzymatic activities of adder venom can be found in Siigur et al(1979). The genomic DNA sequences encoding the phospholipases A2 from the venoms of a number of European vipers have been sequenced, together with genes encoding a number of neurotoxins (Guillemin et al, 2003).

Pathophysiology

  • Only ~50% of bites by exotic venomous snakes inject sufficient venom to cause clinical envenoming (Warrell, 2005). Macintire et al(2005) state that 20% of snakebites are "dry", ie contain little or no toxic venom. The percentage of dry adder bites is uncertain.
  • If injected, the complex nature of adder venom is largely responsible for the range of physiological and clinical effects reported:
    • An immediate drop in systemic blood pressure is commonly seen. This arises through arterial vasodilation, followed by increased peripheral vascular resistance, decreased cardiac output, hypoproteinemia and increased PCV. The hypoproteinemia and hypovolemia probably arise due to increases in vascular permeability and loss of circulating fluid and protein.
    • Bradykinin release may be seen resulting in vasodilation.
    • Phospholipase A2, present in many viperid venoms, can cause release of prostaglandins. This can lead to further vasodilation and hypotension. Phospholipase A2 has significant anticoagulant properties.
    • Anticoagulation effects may be seen resulting in clinical features of a bleeding diathesis.
    • Renal failure can result for a variety of reasons, including myoglobinuria, hemoglobinuria and hypovolemic shock.
    • Serious complications include ventricular arrhythmias, cardiac failure, acute renal failure, DIC Disseminated intravascular coagulation and airway obstruction.
    • Disseminated intravascular coagulation (DIC) can result in hemorrhage, shock, collapse and, sometimes, death.

Timecourse

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Sutton N M, Bates N & Campbell A (2011) Canine adder bites in the UK: a retrospective study of cases reported to the Veterinary Poisons Information Service. Vet Rec 169, 607 PubMed.
  • Pelander L, Ljungvall & Haggstrom J (2010) Myocardial cell damage in 24 dogs bitten by the common European viper (Vipera berus). Vet Rec 166, 687-690 PubMed.
  • Karlson-Stiber C, Salmonson H, Perrson H (2006) A nationwide study of Vipera berus bites during one year-epidemiology and morbidity of 231 cases. Clin Toxicol (Phila) 44 (1), 25-30 PubMed.
  • Warrell D A (2005) Treatment of bites by adders and exotic venomous snakes. Br Med J 331, 1244-1247 PubMed.
  • Guillemin I, Bouchier C, Garrigues T, Wisner A & Choumet V (2003) Sequences and structural organiation of phospholipase A2 genes form Vipera aspis aspisV. aspis zinnikeri and Vipera berus berus venom. Eur J Biochem 270, 2697-2706 PubMed.
  • Kraft W, Reiner B & Bodner C (1998) Snake bites in dogs. Tieraztl Prax Ausg K Klientiere Heimtiere 26 (2), 104-109 PubMed.
  • Reading C J (1996) Incidence, pathology, and treatment of adder (Vipera berus) bites in man. J Acc Emerg Med 13 (5), 346-351 PubMed.
  • Hudelson S & Hudelson P (1995) Pathophysiology of snake envenomization and evaluation of treatments. Comp Cont Ed Pract Vet 17, 1035-1040.
  • Puig J, Villafranca M, Font A, Closa J, Pumarola M & Mascort J (1995) Acute intrinsic renal failure and blood coagulation disorders after a snakebite in a dog. J Small Anim Pract 36 (7), 333-336.
  • Harborne D J (1993) Emergency treatment of adder bites: case reports and literature review. Arch Emerg Med 10 (3), 239-243 PubMed.
  • Siigur E, Siigur J, Nommeots M & Ilomets T (1979) Fractionation and enzymatic activities of common viper (Vipera berus berus) venom. Toxicon 17 (6), 623-630 PubMed.

Other sources of information

  • Macintire D, Drobataz K J, Haskins S C & Saxon W D (2005) Manual of Small Animal Emergency and Critical Care Medicine. Lippincott, Williams and Wilkins, Baltimore, USA.
  • Fowler M E (1992) Veterinary Zootoxicology. Sydney: CRC Press. ASIN:0 8493 6791 3.

Organisation(s)


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