HEMOSTATIC DYSFUNCTION AND ACUTE-RENAL-FAILURE FOLLOWING ENVENOMING BY MERREMS HUMP-NOSED VIPER (HYPNALE-HYPNALE) IN SRI-LANKA - FIRST AUTHENTICATED CASE

A five years old boy was bitten by a Merrem's hump-nosed viper (Hypnal e hypnale) in Central Province, Sri Lanka. He developed local swelling , incoagulable blood, thrombocytopenia, bleeding into the gastrointest inal tract, and acute renal failure. Treatment with Serum Institute of Indian polyspecific antivenom (specific for venoms of cobra, common k rait, Russell's viper and saw-scaled viper) had no effect on the coagu lopathy, which persisted for more than a week. The boy recovered after 27 d in hospital, during which he was treated with peritoneal dialysi s for renal failure. Laboratory studies demonstrated that the venom of H. hypnale was procoagulant, fibrinolytic and aggregated platelets. T his first authenticated case of life-threatening acute renal failure a nd haemostatic disturbances caused by H. hypnale, a species responsibl e for 27% of snake bites in Sri Lanka, demonstrates the need for a new antivenom with specific activity against the venom of this species.