Diksha Sabharwal1, Santosh Govind Rathod2

1Department of Internal Medicine, Hospital and Research Center, Dr. D. Y. Patil College, Pune, Maharashtra, India
2Department of Clinical Hematology, All India Institute of Medical Sciences, Nagpur, Maharashtra, India

Dear Editor,

We read an article by Selamat et al. [1] In the present case, we want to highlight an important aspect in treating green pit viper. Green pit viper venom contains serine proteases, metalloproteinases, C type lectins, and phospholipases.[2] It has procoagulant and anticoagulant effects on the body’s blood clotting mechanism, typically resulting in defibrination syndrome.[2] Phospholipase toxin helps in the subcutaneous spread of venom by lysing the cell membrane. In the present case, envenomation was in the subcutaneous tissue, leading to swelling, edema, cellulitis, and coagulopathy (APTT:65.1 s).[1] In the present case, the patient received only three vials of antisnake after 3 h of bite. Green pit viper does not give dry bites like other venomous snakes. In the present case, the patient received a venomous bite. Given envenomation, the patient should have received the ideal dose of 15 vials of Antisnake venom (ASV) over 6–8 h.[3] ASV neutralizes free circulating venom and does not bind to previously attached receptor sites.

Giving a high dose of Antisnake venom in the early hours works by creating a concentration gradient across the extracellular compartment and sucking out intracellular venom and subsequent decrease in swelling, cellulitis, edema, and the systemic manifestation of envenomation.[2,3] In the present case, despite giving three vials of ASV, swelling progressively increased over 12 h, and the patient required intensive care and tracheostomy for respiratory compromise. In the present case, the dose of ASV was inadequate, allowing the venom to attach its terminal receptors. Giving the ideal dose of ASV in golden hour decreases the mortality and morbidity due to snake bite envenomation. It prevents the extra load of these cases from being sent to the intensive care unit, which is beyond the reach of lower socio economic groups. In private hospitals, treatment cost ranging from US$100 to $1700.[4]

How to cite this article: Sabharwal D, Rathod SG. Local envenomation by green pit viper complicated with airway obstruction. Turk J Emerg Med 2025;25:250.

Author Contributions

Author SGR and author DS concept. All authors reviewed the manuscript.

Conflict of Interest

None declared.

Financial Disclosure

None.

References

  1. Selamat MA, Choon LK, Shamsuddin SR. Local envenomation by green pit viper complicated with airway obstruction. Turk J Emerg Med 2025;25:55 8.
  2. Rathod SG, Dhar A. Saw scaled viper bite and envenomation in the subcutaneous plane. J Family Med Prim Care 2023;12:413 4.
  3. Bawaskar HS, Bawaskar PH. Snake bite poisoning. J Mahatma Gandhi Inst Med Sci 2015;20:5 14.
  4. Bawaskar HS, Bawaskar PH, Bawaskar PH. Snake bite in India: A neglected disease of poverty. Lancet 2017;390:1947 8.