Russell's viper bite in Sri Lanka. A study of 22 cases.

Twenty-two patients who had been bitten by a Russell's viper were studied. Neurological manifestations and generalized myalgia were observed, respectively, in 86.4% and 72.7%. Renal failure did not occur in three patients who received antivenin within 5 hours of the bite, and it is suggested that administration of antivenin within the first few hours following the bite could prevent renal failure. Of 19 patients who were in acute renal failure, seven responded to conservative management while 12 needed peritoneal dialysis. Nine patients developed pulmonary edema and four had grand mal seizures. Five patients died. Autopsy revealed massive pulmonary edema, thought to be the immediate cause of death, in four of them and extensive cortical and tubular necrosis in three.