Trimeresurus macrops ( Dark Green Pit Viper )
Original photo copyright © Dr Anita Malhotra
Family: Viperidae
Subfamily: Crotalinae
Genus: Trimeresurus
Species: macrops
Common Names: Dark Green Pit Viper , Large-eyed Pit
Viper , Kramer's Pit Viper
Local Names: Ngu khiaw Hang Mai
Region: Southeast Asia
Countries: Cambodia, Thailand, Vietnam
Trimeresurus macrops ( Dark Green Pit Viper ) Original photo copyright © Dr Julian White
Taxonomy and Biology
Adult Length: 0.40 m
General Shape: Small in length, moderately slender
bodied snake with tapering prehensile tail. Can grow to a maximum of about 0.75
metres. Head is short, triangular shaped and distinct from narrow neck. Eyes
are large in size, golden yellow, cat-like, with vertically elliptical pupils.
Dorsal scales are keeled except for the first dorsal scale row.
Habitat: Often found among small bush vegetation in
plain and hill terrain up to about 1000 metres. Occasionally enters dwellings
in search of prey and often found in urban areas including Bangkok.
Habits: Arboreal and mainly nocturnal, often seen at
dusk or early morning.
Prey: Feeds mainly on rodents, lizards, birds and
tree frogs.
Venom
General: Venom Neurotoxins
|
Probably not present
|
General: Venom Myotoxins
|
Unknown
|
General: Venom Procoagulants
|
Unknown
|
General: Venom Anticoagulants
|
Unknown
|
General: Venom Haemorrhagins
|
Unknown
|
General: Venom Nephrotoxins
|
Unknown
|
General: Venom Cardiotoxins
|
Probably not present
|
General: Venom Necrotoxins
|
Unknown
|
General: Venom Other
|
Unknown
|
Clinical Effects
General: Dangerousness
|
Unknown, but potentially lethal envenoming, though
unlikely, cannot be excluded
|
General: Rate of Envenoming
|
Unknown but likely to be moderate
|
General: Untreated Lethality Rate
|
Unknown but lethal potential cannot be excluded
|
General: Local Effects
|
Local pain & swelling
|
General: Local Necrosis
|
Does not occur, based on current clinical evidence
|
General: General Systemic Effects
|
Does not occur, based on current clinical evidence
|
General: Neurotoxic Paralysis
|
Unlikely to occur
|
General: Myotoxicity
|
Not likely to occur
|
General: Coagulopathy & Haemorrhages
|
No reports of coagulopathy, though related species can
cause bleeding problems
|
General: Renal Damage
|
Does not occur, based on current clinical evidence
|
General: Cardiotoxicity
|
Unlikely to occur
|
General: Other
|
Does not occur, based on current clinical evidence
|
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
are not recorded, but might cause moderate, possibly major local & systemic
effects, including coagulopathy/bleeding. Urgently assess & admit all
cases. Antivenom therapy is probably 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: 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
Source: Clinical
Toxinology Resources
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