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Trimeresurus puniceus
General Details, Taxonomy and Biology, Venom, Clinical Effects, Treatment, First Aid , Antivenoms
Trimeresurus puniceus  ( Flat nosed Pit Viper )  [ Original photo copyright © Dr Anita Malhotra ]
Family: Viperidae
Subfamily: Crotalinae
Genus: Trimeresurus
Species: puniceus
Common Names
Flat-nosed Pit Viper , Ashy Pit Viper
Local Names
Ular Kapak Hidong Pipeh , Ular Gibuk , Oraj Lemah , Sawah Tadung , Sawah Tadung Bisa , Ular Engkerudu Rau
Southeast Asia
Indonesia, Malaysia, Singapore
Taxonomy and Biology
Adult Length: 0.50 m
General Shape
Small in length, medium bodied snake with a prehensile tail. Can grow to a maximum of about 0.90 metres. Head is large, longer than it is broad, triangular shaped and distinct from neck with a flattened and slightly upturned snout. The snout forms a spatulate or bilobed process overhanging the nostrils and chin. Eyes are medium in size with vertically elliptical pupils. Dorsal scales are weakly keeled.
Found as high as 20 metres above ground level in primary lowland forest and montane forest at elevations up to about 1450 metres.
Mainly an arboreal and nocturnal snake that will descend to the ground in search of prey. A particularly sluggish snake.
Feeds mainly on mice, lizards, tree frogs and birds.
Species Map
Small (Approx 20k) version
General: Venom Neurotoxins
Probably not present
General: Venom Myotoxins
General: Venom Procoagulants
General: Venom Anticoagulants
General: Venom Haemorrhagins
General: Venom Nephrotoxins
General: Venom Cardiotoxins
Probably not present
General: Venom Necrotoxins
General: Venom Other
Clinical Effects
General: Dangerousness
General: Rate of Envenoming: Unknown
General: Untreated Lethality Rate: Unknown
General: Local Effects
Insufficient clinical reports to know, but most likely minor local pain & swelling only
General: Local Necrosis
Insufficient clinical reports to know
General: General Systemic Effects
Insufficient clinical reports to know
General: Neurotoxic Paralysis
Unlikely to occur
General: Myotoxicity
Not likely to occur
General: Coagulopathy & Haemorrhages
No reports of coagulopathy, though related species can cause bleeding problems
General: Renal Damage
Insufficient clinical reports to know
General: Cardiotoxicity
Unlikely to occur
General: Other
Insufficient clinical reports to know
First Aid
Description: First aid for bites by Viperid snakes likely to cause significant local injury at the bite site (see listing in Comments section).
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.
Treatment Summary
Bites by this species are not recorded, but might cause moderate, possibly major local & systemic effects, including coagulopathy/bleeding. Urgently assess & admit all cases. Antivenom therapy is probably the key treatment, especially for coagulopathy.
Key Diagnostic Features
Local pain, swelling, blistering, necrosis + coagulopathy, bleeding
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.
Antivenom Therapy
Antivenom is the key treatment for systemic envenoming. Multiple doses may be required.
1. Antivenom Code: SAsTRC01
Antivenom Name: Green Pit Viper Antivenin
Manufacturer: Science Division, Thai Red Cross Society
Phone: ++66-2-252-0161 (up to 0164)
Address: Queen Saovabha Memorial Institute
1871 Rama IV Road
Bangkok 10330
Country: Thailand
Trimeresurus puniceus ( Flat nosed Pit Viper ) [ Original photo copyright © Dr Anita Malhotra ]
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