Bitis arietans Family: Viperidae Subfamily: Viperinae Genus: Bitis Species: arietans Subspecies: arietans , somalica Common Names Puff Adder , Common Puff Adder , African Puff Adder ( B. a. arietans ) , Somali Puff Adder ( B. a. somalica ) Local Names Gewone Pofadder , Aipomiro , Akipom , Asigirikolongo , Boma , Bulabundo , Chikorviri , Chiva , Coichodo , El Nawama , Essalambwa , Ibululu , Impiri , Ki-iri , Monaroub , Monnarub , Mpomo , Moma , Mpiri , Mpili , Olwero , Pilipili , Uyu , Kassa , M'vumbi , Dolalat , Tarsha , Nawama Region Middle East + North Africa + Sub-Saharan Africa Countries Angola, Benin, Botswana, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Democratic Republic of Congo, Cote d'Ivoire ( Ivory Coast ), Djibouti, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Lesotho, Malawi, Mali, Morocco, Mozambique, Namibia, Niger, Nigeria, Oman, Rwanda, Saudi Arabia, Senegal, Sierra Leone, South Africa, Sudan, Swaziland, Tanzania, Togo, Uganda, Yemen, Zambia, Zimbabwe, West Sahara, Somalia   Taxonomy and Biology Adult Length: 0.70 m General Shape Large in length, thick, extremely stout and heavy bodied snake with a short ( males ) to very short ( females ) tail. Can grow to a maximum of about 1.91 metres ( with a girth of 38 cm ). Saudi Arabian specimens are much smaller, rarely exceeding 0.80 metres. Unusually, the largest specimens are found in semi desert and dry savanna regions. Head is broad, flattened, lanceolate and very distinct from narrow neck. Head is covered with small, keeled, imbricate scales. Snout is short and canthus is distinct. Nostrils are large and face more directly upward than in any other African viper. Eyes are medium in size with vertically elliptical pupils. Dorsal scales are heavily keeled with apical pits ( outer scale row is smooth or feebly keeled ). Habitat Very adaptable to a wide range of habitats ( including savanna, scrub and semi-desert ) up to about 3500 metres elevation. Only absent from true desert, tropical rainforest and very high montane grassland and peaks. Habits Terrestrial, mainly nocturnal and very sluggish snake. Emerges at dusk and remains hidden in cover ( effective camouflage ) ready to ambush prey. If disturbed it inflates its body with air and exhaling in loud hisses or puffs ( hence its common name ) and will adopt a striking posture with the anterior body held in a taut S shape. At the same time though, it edges itself backward into cover. It will strike readily and swiftly if cornered or provoked. Often swims, but on land moves with a caterpillar like motion leaving a straight track in sand or loose soil. Prey Feeds on a wide variety of prey, including hares, hedgehogs, grasshoppers and cockroaches but most often on rodents, small mammals, lizards and birds, occasionally other snakes. An opportunistic feeder. Young feed mainly on toads and frogs. Species Map Small (Approx 20k) version   Venom Average Venom Qty 130 to 200 mg ( dry weight ), U.S. Dept. Navy (1968) ( Ref : R000914 ). 160 to 200 mg ( dry weight ), Minton (1974) ( Ref : R000504 ). General: Venom Neurotoxins Not present General: Venom Myotoxins Not present General: Venom Procoagulants Possibly present General: Venom Anticoagulants Possibly present General: Venom Haemorrhagins Present but not defined General: Venom Nephrotoxins Possibly present General: Venom Cardiotoxins Not present General: Venom Necrotoxins Present but not defined General: Venom Other Unknown   Clinical Effects General: Dangerousness Severe envenoming possible, potentially lethal General: Rate of Envenoming: 60-80% General: Untreated Lethality Rate: Unknown General: Local Effects Marked local effects; pain, severe swelling, bruising, blistering General: Local Necrosis Very common, moderate to severe 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 Common, moderate to severe coagulopathy + haemorrhagins causing extensive bleeding General: Renal Damage Rare, usually secondary effect General: Cardiotoxicity Common, cardiotoxicity is major clinical effect General: Other Shock secondary to fluid shifts due to local tissue injury is likely in severe cases   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). 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.   Treatment Treatment Summary Puff adder bites are likely to cause severe local & systemic envenoming rapidly, requiring urgent assessment & treatment. Fluid shift & shock may occur. Urgent fluid load, good wound care and antivenom are required. While compartment syndrome can occur, it must be confirmed by pressure measurement before considering fasciotomy. Beware any surgical intervention while venom haemorrhagins are active. Key Diagnostic Features Local 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. Antivenoms 1. Antivenom Code: SAfSAI03 Antivenom Name: SAIMR Polyvalent Antivenom Manufacturer: South African Vaccine Producers (Pty) Ltd Phone: +27 11 386-6000; +27 11 386-6078 Address: Postal address PO Box 28999 Sandringham 2131 Gauteng Province Physical address 1 Modderfontein Road Sandringham, Johannesburg Country: South Africa 2. Antivenom Code: SAfSAIBK Antivenom Name: SAIMR Snakebite Kit Manufacturer: South African Vaccine Producers (Pty) Ltd Phone: +27 11 386-6000; +27 11 386-6078 Address: Postal address PO Box 28999 Sandringham 2131 Gauteng Province Physical address 1 Modderfontein Road Sandringham, Johannesburg Country: South Africa 3. Antivenom Code: SAfAVC02 Antivenom Name: Polyvalent Snake Antivenom Manufacturer: National Antivenom and Vaccine Production Centre Phone: ++966-1-252-0088 ext 45626, 45637. Address: P.O. Box 22490 Riyadh 11426 Country: Saudi Arabia 4. Antivenom Code: SAfIBM01 Antivenom Name: Antivipmyn Africa Manufacturer: Instituto Bioclon Phone: ++56-65-41-11 Address: Calzada de Tlalpan No. 4687 Toriello Guerra C.P. 14050 Mexico, D.F., Country: Mexico 5. Antivenom Code: SAfICP07 Antivenom Name: Pan-African antivenom (EchiTAb-Plus-ICP) Manufacturer: Instituto Clodomiro Picado Phone: ++506-2511-7888 Address: Contiguo a la plaza de deportes, Dulce Nombre de Coronado. San José Costa Rica Country: Costa Rica 6. Antivenom Code: SAfVAC02 Antivenom Name: Polyvalent Snake Venom Antiserum Manufacturer: VACSERA Phone: (+20 2) 3761-1111 Address: 51 Wezaret El Zeraa St., Agouza, Giza, 22311 Country: Egypt 7. Antivenom Code: SAfSPF02 Antivenom Name: FAV-Afrique Manufacturer: Sanofi-Pasteur Phone: +33 (0)4 37 37 01 00 Address: 2, Avenue Pont Pasteur, CEDEX 07, Lyon 69367 Country: France 8. Antivenom Code: SAfSPF03 Antivenom Name: Favirept Manufacturer: Sanofi-Pasteur Phone: +33 (0)4 37 37 01 00 Address: 2, Avenue Pont Pasteur, CEDEX 07, Lyon 69367 Country: France   Images Bitis arietans ( Puff Adder ) [ Original photo copyright © Dr Julian White ] Bitis arietans ( Puff Adder ) [ Original photo copyright © Dr Julian White ] Bitis arietans ( Puff Adder ) [ Original photo copyright © Dr Julian White ] Bitis arietans ( Puff Adder ) [ Original photo copyright © Franck Principaud] Click here for larger version Click here for larger version Click here for larger version Click here for larger version