Rhabdophis subminiatus Family: Colubridae Subfamily: Natricinae Genus: Rhabdophis Species: subminiatus Subspecies: subminiatus , helleri Common Names Red-necked Keelback , Heller's Keelback ( R. s. helleri ) Local Names Ular Pitjung , Ular Lempeh Region Indian Sub-continent + North Asia + Southeast Asia Countries Bangladesh, Bhutan, Brunei, Cambodia, China, Hong Kong, Indonesia, India, Laos, Malaysia, Myanmar, Philippines, Singapore, Thailand, Vietnam   Taxonomy and Biology Adult Length: 0.50 m General Shape Medium in length, moderately slender bodied snake with moderately long and slender tail. Can grow to a maximum of about 1.30 metres. Head is moderately distinct from neck, slightly elongate with a prominent brow ridge. Eyes are moderately large in size with round pupils. Dorsal scales are keeled with the outer rows smooth. Dorsal scale count usually 21 - 19 - 17. Habitat Wide variety of habitats throughout its tropical and subtropical mainland and island range. Found in wet forest, paddy fields, grasslands and marshes especially along streams or in lowlands or foothills near rivers and streams. Often found in or around rubber plantations. Habits Mainly terrestrial and diurnal but often seen swimming. Inoffensive disposition. It tends to flatten its body if disturbed and will strike if provoked or handled. Prey Feeds mainly on frogs, toads, small mammals and fish. Species Map Small (Approx 20k) version   Venom Average Venom Qty 10 to 15 µl ( liquid volume), Ferlan et al (1983) ( Ref : R000475 ). General: Venom Neurotoxins Not present General: Venom Myotoxins Not present General: Venom Procoagulants Mixture of procoagulants General: Venom Anticoagulants Possibly present General: Venom Haemorrhagins Possibly present General: Venom Nephrotoxins Not present General: Venom Cardiotoxins Not present General: Venom Necrotoxins Not present General: Venom Other Not present or not significant   Clinical Effects General: Dangerousness Severe envenoming possible, potentially lethal General: Rate of Envenoming: Unknown General: Untreated Lethality Rate: Unknown but has caused deaths General: Local Effects Local pain, swelling, bruising & bleeding General: Local Necrosis Not likely to occur General: General Systemic Effects Variable non-specific effects which may include headache, nausea, vomiting, abdominal pain, diarrhoea, dizziness, collapse or convulsions General: Neurotoxic Paralysis Unlikely to occur General: Myotoxicity Not likely to occur General: Coagulopathy & Haemorrhages Uncommon to rare, but may be moderate to severe coagulopathy General: Renal Damage Recognised complication, usually secondary to coagulopathy General: Cardiotoxicity Unlikely to occur General: Other Not likely to occur   First Aid Description: First aid for potentially dangerous non-front-fanged colubroid snakes (see listing in Comments section). 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. If the bite is on a limb, a broad bandage (even torn strips of clothing or pantyhose) should be applied over the bitten area at moderate pressure (as for a sprain; not so tight circulation is impaired), then extended to cover as much of the bitten limb as possible, including fingers or toes, going over the top of clothing rather than risking excessive limb movement by removing clothing. The bitten limb should then be immobilised as effectively as possible using an extemporised splint or sling. 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. In Australia and parts of New Guinea, Snake Venom Detection Kits are available to identify the snake from venom left on the skin. 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 Treatment Summary Capable of major envenoming, with potentially lethal coagulopathy, reversible with specific antivenom therapy, less certainly with Cryoprecipitate/FFP, no role for heparin. Key Diagnostic Features Local pain, swelling + coagulopathy & haemorrhage 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. Antivenoms 1. Antivenom Code: SAsJSI01 Antivenom Name: Anti-Yamakagashi Antivenom Manufacturer: The Japan Snake Institute Phone: ++81-277-78-5193 Address: Yabuzuka-honmachi Nittagun, Gunma Prefecture 379-2301 Country: Japan   Images Rhabdophis subminiatus ( Red necked Keelback ) [ Original photo copyright © Dr Julian White ] Rhabdophis subminiatus ( Red necked Keelback ) [ Original photo copyright © Dr Wolfgang Wuster ] Click here for larger version Click here for larger version