clinical features
Last reviewed 07/2021
Localised features:
- immediate sharp pain occurs secondary to the adder bite
- after a period of time (generally within a few minutes but sometimes up to more than 30 minutes later) there is a sensation of tingling and local swelling that spreads proximally
- uncommon for local blisters containing blood to occur at the site of the adder bite
- within hours of the adder bite there is occasionally a spreading pain, tenderness, inflammation, and tender enlargement of regional lymph nodes - this process is often described as "cellulitis" but this is misleading because there is no infection (1)
- the whole limb affected by the adder bite may become bruised and swollen within 24 hour; there also may be generalised swelling and bruising secondary to an adder bite in children
- intracompartmental syndromes and necrosis are very rare
Systemic features:
- anaphylaxis
may occur
- may appear within five minutes of the bite or may be delayed for many hours
- possible systemic features include nausea; vomiting; abdominal colic; diarrhoea; faecal incontinence; urinary incontinence; sweating; fever; vasoconstriction; tachycardia; hypotension (this is often the most critical sign and generally develops within the first few hours following the adder bite and may spontaneously resolve, persist, recur or progress with fatal consequences); loss of consciousness; shock; angiooedema; urticaria; and bronchospasm
- features may persist or fluctuate for as long as 48 hours in the absence of treatment
-
a bleeding diathesis is unusual - however bleeding from various sites (including
the gums and nose, lungs, gastrointestinal and genitourinary tracts, and serosal
cavities and retroperitoneum) can occur
- risk of bleeding is greatly increased by inappropriate treatment with heparin
- rare systemic features include haemothorax, massive upper gastrointestinal bleeding, haematuria, and intrauterine fetal death
- acute renal failure may occur - this has particularly been reported in adder bites in children
- generalised oedema may occur
- occurence of coma and seizures may occur secondary to profound hypotension, cerebral oedema, hyponatraemia, hypoalbuminaemia, or hypoxaemia secondary to respiratory distress
- rare systemic complications that have been reported include cardiac arrest, acute pancreatitis and paralytic ileus
Reference: