SPOT 1 - Russell's Viper (Daboia russelii)

a) Identify the Spot

• Head: Distinctly triangular/arrow-shaped head, noticeably wider than the neck - a hallmark of vipers
• Body pattern: Three rows of dark, oval/chain-like spots running along the entire length of the body (the classic "chain viper" pattern)
• Scales: Small, fragmented scales covering the head (not large shields as in non-venomous snakes)
• Broad ventral scales: Complete transverse plates across the belly, characteristic of terrestrial venomous snakes

b) Clinical Signs

• Severe local pain and rapid, massive swelling at the bite site
• Blistering, ecchymosis, and local tissue necrosis
• Prolonged oozing/bleeding from the bite wound

• Coagulopathy/DIC: Bleeding from gums (gingival bleeding), epistaxis, hematuria, hematemesis, prolonged clotting time
• Renal: Acute Kidney Injury (AKI) - oliguria, anuria (one of the most common causes of AKI due to snakebite in India)
• Cardiovascular: Hypotension, shock
• Neurological (in South Indian subspecies): Ptosis, ophthalmoplegia (neurotoxic features - unique to D. russelii pulchella)
• Pituitary hemorrhage: Sheehan-like syndrome (anterior pituitary necrosis) in survivors

c) Poisonous / Non-Poisonous

d) Antidote

• Specifically: Polyvalent Anti-Snake Venom Serum (ASVS) - effective against all four of India's Big Four snakes
• Manufactured from horse serum (equine origin)
• Route: IV infusion (preferred) or IM
• Dose: 10 vials initially; repeat every 1-2 hours if symptoms persist (there is no upper limit - dose titrated to response)
• Specific indications for ASV in Russell's viper bite: any coagulopathy, local necrosis, renal failure, hypotension, or bleeding manifestations
• No specific monovalent antivenom is routinely available in India for Russell's Viper alone