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Family: Viperidae
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Subfamily: Viperinae
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Genus: Macrovipera
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Species: lebetina
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Subspecies: turanica
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Common Names
( subsp. turanica ) Levantine Viper , East Asian Blunt-nosed Viper , Levant Viper , Lebetine Viper , Gorzeh Snake
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Region
West Asia + Indian Sub-continent + Middle East
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Countries
Afghanistan, India, Iran, Pakistan, Turkmenistan, Uzbekistan
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Taxonomy and Biology
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Adult Length: 1.00 m
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General Shape
Medium in length, cylindrical, stout bodied snake with a short tail that tapers abruptly. Can grow to a maximum of about 1.71 metres. Head is triangular when viewed from above, relatively long and distinct from neck. Snout is blunt. Canthus rostralis is distinct. Nostrils are located laterally. Eyes are medium in size with vertically elliptical pupils. Dorsal scales are keeled. Ventrals not keeled. Dorsal scale count ( 23 to 25 ) - ( 23 to 27 ) - 19.
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Habitat
Between about 1000 and 2400 metres in semiarid, rocky and mountainous terrain with sparse to heavy vegetation.
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Habits
Nocturnal and terrestrial snake. If encountered during the day, it is very sluggish and seldom responds to any stimulus. However, at night, it moves and strikes quickly at night and will respond to the slightest provocation. It will climb low bushes.
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Prey
Juveniles feed mainly on lizards. Adults feed mainly on small mammals, birds and their eggs.
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Venom
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Average Venom Qty
47 ± 16 mg ( dry weight ), Latifi (1985) ( Ref : R000770 ).
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General: Venom Neurotoxins
Probably not present
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General: Venom Myotoxins
Probably present, but not confirmed.
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General: Venom Procoagulants
Fibrinogenases
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General: Venom Anticoagulants
Probably not present
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General: Venom Haemorrhagins
Probably present
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General: Venom Nephrotoxins
Probably not present
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General: Venom Cardiotoxins
Probably not present
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General: Venom Necrotoxins
Possibly present
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General: Venom Other
Not present or not significant
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Clinical Effects
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General: Dangerousness
Severe envenoming possible, potentially lethal
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General: Rate of Envenoming: Unknown but likely to be high
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General: Untreated Lethality Rate: Unknown but has caused deaths
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General: Local Effects
Marked local effects; pain, severe swelling, bruising, blistering, necrosis
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General: Local Necrosis
Can be moderate to severe
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General: General Systemic Effects
Variable non-specific effects which may include headache, nausea, vomiting, abdominal pain, diarrhoea, dizziness, collapse or convulsions
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General: Neurotoxic Paralysis
Does not occur, based on current clinical evidence
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General: Myotoxicity
Does not occur, based on current clinical evidence
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General: Coagulopathy & Haemorrhages
Common, moderate to severe coagulopathy + haemorrhagins causing extensive bleeding
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General: Renal Damage
Recognised complication, usually secondary to coagulopathy
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General: Cardiotoxicity
Does not occur, based on current clinical evidence
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General: Other
Shock secondary to fluid shifts due to local tissue injury is likely in severe cases
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First Aid
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Description: First aid for bites by Viperid snakes likely to cause significant local injury at the bite site (see listing in Comments section).
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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.
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Treatment
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Treatment Summary
Bites may cause mild to severe local effects, shock & coagulopathy. All cases should be managed as potentially severe. Shock should be monitored for and vigorously treated. Specific antivenom is available only for some Vipera species, but should be used in all but minor envenoming cases.
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Key Diagnostic Features
Local pain, swelling, blistering, necrosis + coagulopathy, bleeding
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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.
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Antivenom Therapy
Antivenom is the key treatment for systemic envenoming. Multiple doses may be required.
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| 1. Antivenom Code: SAfIPA02
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Antivenom Name: Anti-viperin (Bivalent)
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Manufacturer: Institut Pasteur d_Algerie
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Phone: ++213-21-67-25-02
++213-21-67-25-11
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Address: Rue du Docteur Laveran,
16000 Alger
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Country: Algeria
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| 2. Antivenom Code: SAsRII02
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Antivenom Name: Polyvalent Snake Antivenin
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Manufacturer: Razi Serum and Vaccine Research Institute
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Phone: +98 261 3119708
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Address: Iran Karaj P.O. Box : 31975/148 Post No. :3197619751
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Country: I.R. Iran
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| 3. Antivenom Code: SEuIZC01
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Antivenom Name: Viper Venom Antitoxin, European
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Manufacturer: Institute of Immunology, Inc.
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Phone: ++385-1-468-4500
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Address: PO Box 266
Rockefellerova Street 2
10000 Zagreb
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Country: Croatia
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| 4. Antivenom Code: SEuIIV01
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Antivenom Name: Viper Venom Antitoxin
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Manufacturer: Torlak, Institute of Immunology and Virology
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Phone: +381-11-3976-674
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Address: 458 Vojvode Stepe St.
11152 Belgrade
P.O. Box 1, Serbia and Montenegro
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Country: Yugoslavia
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| 5. Antivenom Code: SAfIPM02
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Antivenom Name: Antiviperin Sera
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Manufacturer: Institut Pasteur du Maroc
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Phone: Tél standard +212 22 43 44 50
Tél Expertise +212 22 43 44 75
Tél Médical +212 22 43 44 68
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Address: Place Louis Pasteur
20100 Casablanca Maroc
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Country: Morocco
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| 6. Antivenom Code: SAfIPT02
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Antivenom Name: Antiviperin Sera
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Manufacturer: Institut Pasteur du Tunis
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Phone: ++21-61-283022
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Address: 13 Place Pasteur,
B.P. 74
1002 Tunis-Belvedere,
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Country: Tunisia
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| 7. Antivenom Code: SAfVAC02
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Antivenom Name: Polyvalent Snake Venom Antiserum
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Manufacturer: VACSERA
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Phone: (+20 2) 3761-1111
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Address: 51 Wezaret El Zeraa St., Agouza, Giza, 22311
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Country: Egypt
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