Heart Damage following Adder Bite in England.

The common adder (Vipera berus) is the only indigenous poisonous snake in Britain, its venom is of relatively low toxicity, and death due to adder bite is rare in adults (Manson-Bahr, 1957). We report here a case of snake bite of extreme severity associated with a most unusual cardiac complication. Case History The patient, a fit 22-year-old ex-paratrooper, was invited to see a "grass-snake" that had been captured three days previously in the Cheviot Hills. Since capture, the snake had been kept without food or water in the warm cab of a lorry, and bit the patient on his left forefinger. A few minutes later as the wound was being cleaned he noticed a light-headed sensation but feeling otherwise well he started walking to the nearest doctor's surgery. About 15 minutes later a passing motorist found him staggering along the road, stopped, helped him into his car, and brought him to the Royal Victoria Infirmary. By the time he arrived at the hospital (approximately 30 minutes after the bite) he had developed abdominal colic. Later he started to vomit and become incontinent of large amounts of watery diarrhoea. About one hour after the bite his blood pressure fell to barely recordable levels and he lost consciousness. Intravenous normal saline with hydrocortisone and noradrenaline was started and about one and a half hours after the bite 15 ml. of anti-venomous serum (Pasteur Institute) was given after a negative test dose of 0 5 ml. the same evening. The snake, which had been killed and partly burned, was brought in and identified as an adder. During the first 12 hours a total of 3 litres of normal saline, 500 ml. plasma, 300 mg. hydrocortisone, and 24 mg. noradrenaline were administered. His wound was dressed and intramuscular tetracycline started. Within one hour of admission the diarrhoea had stopped, the blood pressure rose to 100/60 mm. Hg, where it remained and he felt much better. Local reaction to the bite, however, increased and he developed an ascending lymphangitis with axillary lymphadenitis, increasing cedema, and ecchymosis. The oedema extended up into his neck and tongue and in an effort to prevent laryngeal acdema chlorpheniramine (Piriton) 10 mg. intramuscularly was given every 8 hours with good effect. Over the next 12 hours normal saline and 5 per cent dextrose were given alternately at a rate of 1 litre per 8 hours, and 1 mg. noradrenaline hourly …