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Family: Viperidae
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Subfamily: Crotalinae
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Genus: Gloydius
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Species: blomhoffii
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Subspecies: dubitatus
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Common Names
( subsp. dubitatus ) Mamushi , Tung Ling Mamushi
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Region
North Asia
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Countries
China
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Taxonomy and Biology
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Adult Length: 0.40 m
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General Shape
Small in length, medium bodied snake with short tapering tail. Can grow to a maximum of about 0.60 metres. Head is broad, flattened, triangular and distinct from neck. Eyes are medium in size with vertically elliptical pupils. Dorsal scales are keeled with paired apical pits. Dorsal scale count 21 - 21 - 17.
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Habitat
Deciduous broad leaved forest and woodlands.
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Habits
Mainly nocturnal and semi-arboreal.
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Prey
Feeds on a vriety of prey including frogs, lizards, small snakes, fish, birds and rodents.
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Venom
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General: Venom Neurotoxins
Pre- & Post-synaptic neurotoxins probably present
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General: Venom Myotoxins
Probably present, but not confirmed.
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General: Venom Procoagulants
Fibrinogenases probably present
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General: Venom Anticoagulants
Possibly present
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General: Venom Haemorrhagins
Possibly 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
Unknown
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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 lethal potential cannot be excluded
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General: Local Effects
Moderate, occasionally marked local effects; pain, severe swelling, bruising, blistering, necrosis
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General: Local Necrosis
Uncommon but 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, tachypnoea, respiratory distress, hypotension, dizziness, collapse or convulsions
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General: Neurotoxic Paralysis
Commonly develop flaccid paralysis
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General: Myotoxicity
Not definitely proven, but suspected in some cases.
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General: Coagulopathy & Haemorrhages
Uncommon to rare, but may be moderate to severe coiagulopathy
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General: Renal Damage
Recognised complication, usually secondary to coagulopathy
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General: Cardiotoxicity
Rare, usually secondary
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General: Other
Shock secondary to fluid shifts due to local tissue injury is possible 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
Chinese Mamushi bites cause local ± systemic effects. Urgently assess, admit, IV fluids, IV antivenom for all but mild local effects.
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Key Diagnostic Features
Local pain, swelling, blistering, necrosis ± flaccid paralysis
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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. However, availability is uncertain.
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| 1. Antivenom Code: SAsTCI01
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Antivenom Name: Freeze-dried Mamushi Antivenom, Equine "Takeda"
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Manufacturer: Takeda Chemical Industries Ltd.
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Phone: +81-6-6204-2111
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Address: 1-1, Doshomachi 4-Chome
Chuo-ku
Osaka
540-8645
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Country: Japan
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| 2. Antivenom Code: SAsKKJ01
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Antivenom Name: Freeze-dried Mamushi Antivenom "Kaketsuken"
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Manufacturer: The Chemo-Sero-Therapeutic Research Institute (Kaketsuken)
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Phone: ++81-96-344-1211 or 345-6500
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Address: 1-6-1 Okubo,
Kumamoto-shi
Kumamoto 860-8568
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Country: Japan
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