This document provides information on managing snake bites. It lists the common venomous snakes in Sri Lanka including kraits, cobras, Russell's vipers, saw-scaled vipers, and hump-nosed vipers. The main components of snake venom are described as proteins, enzymes, and polypeptides that can cause coagulation, hemorrhaging, cell destruction, and neurological effects depending on the type of snake. Management of envenomation is outlined including local effects, coagulopathy, neurotoxicity, renal toxicity based on the snake species. Anti-venom therapy is the primary treatment described.

1. MANAGEMENT
OF
SNAKE BITES

2. Epidemiology

3. Making snake-bite a notifiable disease
 April – 2016
 Letter was addressed to DGHS
 SNAKE BITE be made a notifiable disease by
general circular
 Form is circulated to all hospitals
 Implementation is still pending….

4. List of Venomous land snakes

5. IDENTIFICATION OF VENOMOUS SNAKES

6. KRAITS
1. Black snake with single or paired white bands
2. Enlarged Vertebral scales are much larger than costals

8. Sri Lankan Krait
Common Krait / Indian Krait

9. KRAIT mimics

10. Wolf snake Krait

11. COBRA

13. RUSSELL’S VIPER

15. SAW-SCALED VIPER

17. HUMP-NOSED VIPER

21. SNAKE VENOM
 More than 20 different constituents.
 Mainly proteins, enzymes and polypeptides.
 Procoagulation enzymes & polypeptide toxins
 Haemorrhagins
 Cytolytic and necrotic toxins
 Haemolytic and myolytic phospholipases A2
 Pre-synaptic neurotoxins – Kraits, sea snakes
 Post-synaptic neurotoxins – Cobra

22. Summary of selected manifestations of
envenomation
Local effects Coagulopathy Neurotoxicity Renal toxicity
Russell’s viper ++ +++ + +
Cobra +++ - ++ -
Krait - - +++ -
Saw-scaled viper ++ ++ - -
Hump-nosed viper ++ + - +
Green pit-viper ++ + - -
Sea snake - - +/- Myotoxicity -

24. Anti-Venom Therapy

29. 20WBCT