Adder (Vipera berus) bite

Extract

• Vipera berus, i.e. the common European adder (or viper) is widespread in northern, central and eastern Europe, Britain, as well as Asia.
  • The adder or viper is the only naturally occurring poisonous snake in the Nordic countries.
  • In Finland, the annual number of bites is estimated at 50–150; there are no exact statistics available.
• Fatal bites are rare in healthy adults but possible. Risk groups include children, elderly people, multimorbid patients and pregnant women.
• The exact composition of the venom is unknown, and it may vary.
  • The venom causes direct destruction at the bite site and elsewhere in the body depending on its systemic transportation (proteolysis, haemolysis, cytotoxic effects).
  • In addition, it may release mediators (such as histamine, bradykinin, serotonin), which may lead to an anaphylactoid reaction.
  • Systemically, the venom may trigger a sepsis-type cytokine storm.
• The bite may be a warning without venom, i.e., a ‘dry bite’. On the other hand, symptoms may develop with significant delay; make sure to follow up the patient for a sufficiently long time!
• Moving or agitation after the bite will speed up absorption of the venom through lymph vessels into the systemic circulation.
  • At the accident site, the person should not be asked to walk, and the bite site should not be touched.
  • Any jewellery or tight clothes should be removed before the site begins to swell.
  • All other actions (such as applying a tourniquet, sucking the venom, applying ice cubes to the site, etc.) are either harmful or useless.
• Glucocorticoids (in OTC snake bite kits or equivalent given at the accident site or later therapy at hospital) have not been shown to be beneficial regarding the severity of the developing symptoms or subsequent healing.
• Essential aspects of treatment
  • Keep the patient and the bite site still and calm. Ensure sufficient analgesia (e.g. opioids) at the time of initial treatment, already.
  • Ensure constant monitoring: any organ failure may develop suddenly. Treat organ failure symptomatically.
  • Follow up local symptoms, repeatedly marking the limits of the lesions with a marker and measuring the limb circumference
  • Consider starting administration of the specific antidote at an early stage. See local guidelines.

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