Cambodia - Very Venomous Snakes Found - Trimeresurus albolabris

Trimeresurus albolabris ( White lipped Green Pit Viper )

Original photo copyright © Dr Anita Malhotra

Family: Viperidae

Subfamily: Crotalinae

Genus: Trimeresurus

Species: albolabris

Common Names: White-lipped Green Pit Viper , White-lipped Pit Viper , White-lipped Tree Viper

Local Names: Bai Chun Zhu Ye Qing , Ngu khiaw Hang Mai , Ran Luc Mep Trang

Region: Indian Sub-continent + North Asia + Southeast Asia

Countries: Bangladesh, Cambodia, China, Hong Kong, Indonesia, India, Laos, Malaysia, Myanmar, Nepal, Taiwan, Thailand, Vietnam

Trimeresurus albolabris ( White lipped Green Pit Viper ) Original photo copyright © Dr Julian White

Taxonomy and Biology

Adult Length: 0.40 m

General Shape: Small in length, medium to moderately stout bodied snake with a short, prehensile tail ( females much larger than males ). Can grow to a maximum of about 1.04 metres. Head is triangular shaped, distinct from narrow neck and relatively elongate when compared with other species from this genus ( in particular T. popeiorum ). Eyes are medium in size, yellow, with vertically elliptical pupils. Dorsal scales are keeled. Dorsal scale count 21 ( 19 to 25 ) - 21 ( 19 or 23 ) - 15 ( 17 ).

Habitat: Most often found among small bush vegetation in plain and hill terrain up to about 1000 metres in bamboo forest, moist lowland subtropical forest and temperate forest. Occasionally enters dwellings in search of prey and often found in urban areas including Bangkok.

Habits: Nocturnal and semi-arboreal, but found both on the ground ( mainly at night ) and in trees ( mainly during the day ). Quick to bite if touched or approached too closely preferring to strike rather than escape.

Prey: Feeds mainly on rodents, lizards, birds and frogs.

Trimeresurus albolabris ( White lipped Green Pit Viper ) Original photo copyright © Dr Julian White

Venom

General: Venom Neurotoxins	Not present
General: Venom Myotoxins	Not present
General: Venom Procoagulants	Fibrinogenases
General: Venom Anticoagulants	Probably not present
General: Venom Haemorrhagins	Possibly present
General: Venom Nephrotoxins	Probably not present
General: Venom Cardiotoxins	Not present
General: Venom Necrotoxins	Probably not present
General: Venom Other	Not present or not significant

Trimeresurus albolabris ( White lipped Green Pit Viper ) Original photo copyright © Franck Principaud

Clinical Effects

General: Dangerousness	Severe envenoming possible, potentially lethal
General: Rate of Envenoming	Unknown but likely to be high
General: Untreated Lethality Rate	1-10%
General: Local Effects	Local pain, swelling, bruising & blistering
General: Local Necrosis	Rarely occurs, minor only
General: General Systemic Effects	Variable non-specific effects which may include headache, nausea, vomiting, abdominal pain, diarrhoea, dizziness, collapse or convulsions
General: Neurotoxic Paralysis	Does not occur, based on current clinical evidence
General: Myotoxicity	Does not occur, based on current clinical evidence
General: Coagulopathy & Haemorrhages	Common, moderate to severe coagulopathy + haemorrhagins causing extensive bleeding
General: Renal Damage	Rare, usually secondary effect
General: Cardiotoxicity	Does not occur, based on current clinical evidence
General: Other	Shock secondary to fluid shifts due to local tissue injury is likely in severe cases

Trimeresurus albolabris ( White lipped Green Pit Viper ) Original photo copyright © Franck Principaud

First Aid

Description:

First aid for bites by Viperid snakes likely to cause significant local injury at the bite site.

Details

1. After ensuring the patient and onlookers have moved out of range of further strikes by the snake, the bitten person should be reassured and persuaded to lie down and remain still. Many will be terrified, fearing sudden death and, in this mood, they may behave irrationally or even hysterically. The basis for reassurance is the fact that many venomous bites do not result in envenoming, the relatively slow progression to severe envenoming (hours following elapid bites, days following viper bites) and the effectiveness of modern medical treatment.

2. The bite wound should not be tampered with in any way. Wiping it once with a damp cloth to remove surface venom is unlikely to do much harm (or good) but the wound must not be massaged.

3. All rings or other jewellery on the bitten limb, especially on fingers, should be removed, as they may act as tourniquets if oedema develops.

4. The bitten limb should be immobilised as effectively as possible using an extemporised splint or sling; if available, crepe bandaging of the splinted limb is an effective form of immobilisation.

5. If there is any impairment of vital functions, such as problems with respiration, airway, circulation, heart function, these must be supported as a priority. In particular, for bites causing flaccid paralysis, including respiratory paralysis, both airway and respiration may be impaired, requiring urgent and prolonged treatment, which may include the mouth to mask (mouth to mouth) technique of expired air transfer. Seek urgent medical attention.

6. Do not use Tourniquets, cut, suck or scarify the wound or apply chemicals or electric shock.

7. Avoid peroral intake, absolutely no alcohol. No sedatives outside hospital. If there will be considerable delay before reaching medical aid, measured in several hours to days, then give clear fluids by mouth to prevent dehydration.

8. If the offending snake has been killed it should be brought with the patient for identification (only relevant in areas where there are more than one naturally occurring venomous snake species), but be careful to avoid touching the head, as even a dead snake can envenom. No attempt should be made to pursue the snake into the undergrowth as this will risk further bites.

9. The snakebite victim should be transported as quickly and as passively as possible to the nearest place where they can be seen by a medically-trained person (health station, dispensary, clinic or hospital). The bitten limb must not be exercised as muscular contraction will promote systemic absorption of venom. If no motor vehicle or boat is available, the patient can be carried on a stretcher or hurdle, on the pillion or crossbar of a bicycle or on someone's back.

10. Most traditional, and many of the more recently fashionable, first aid measures are useless and potentially dangerous. These include local cauterization, incision, excision, amputation, suction by mouth, vacuum pump or syringe, combined incision and suction ("venom-ex" apparatus), injection or instillation of compounds such as potassium permanganate, phenol (carbolic soap) and trypsin, application of electric shocks or ice (cryotherapy), use of traditional herbal, folk and other remedies including the ingestion of emetic plant products and parts of the snake, multiple incisions, tattooing and so on.

Treatment

Treatment Summary: Bites by this species can cause major local & systemic effects, including coagulopathy/bleeding. Urgently assess & admit all cases. Antivenom therapy is the key treatment, especially for coagulopathy.

Key Diagnostic Features: Local pain, swelling, blistering, necrosis + coagulopathy, bleeding

General Approach to Management: All cases should be treated as urgent & potentially lethal. Rapid assessment & commencement of treatment including appropriate antivenom (if indicated & available) is mandatory. Admit all cases.

Antivenom Therapy: Antivenom is the key treatment for systemic envenoming. Multiple doses may be required.

Antivenoms

1. Antivenom Code: SAsCRI01

Antivenom Name: Polyvalent Anti Snake Venom Serum

Manufacturer: Central Research Institute

Phone: ++91-1-792-72114

Address: Kasauli (H.P.) 173204

Country: India

2. Antivenom Code: SAsTRC01

Antivenom Name: Green Pit Viper Antivenin

Manufacturer: Science Division, Thai Red Cross Society

Phone: ++66-2-252-0161 (up to 0164)

Address: Queen Saovabha Memorial Institute

1871 Rama IV Road

Pathumwan

Bangkok 10330

Country: Thailand

3. Antivenom Code: SAsSII01

Antivenom Name: SII Polyvalent Antisnake Venom Serum ( lyophilized )

Manufacturer: Serum Institute of India Ltd.

Phone: +91-20-26993900

Address: 212/2, Hadapsar,

Off Soli Poonawalla Road,

Pune-411042. India

Country: India

4. Antivenom Code: SAsSII02

Antivenom Name: SII Bivalent Antisnake Venom Serum ( lyophilized )

Manufacturer: Serum Institute of India Ltd.

Phone: +91-20-26993900

Address: 212/2, Hadapsar,

Off Soli Poonawalla Road,

Pune-411042. India

Country: India

5. Antivenom Code: SAsVCT02

Antivenom Name: Bivalent Antivenin Pit Viper, Trimeresurus antivenin

Manufacturer: National Institute of Preventative Medicine

Phone: +886-2-2395-9825

Address: Linshen Office Address:

No.6, Linshen S. Rd., Taipei, Taiwan 100,

R.O.C.

Kunyang Office Address:

No.161, KunYang St., Taipei, Taiwan 115,

R.O.C.

Country: Taiwan

Source: Clinical Toxinology Resources