{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,28]],"date-time":"2026-03-28T18:56:59Z","timestamp":1774724219080,"version":"3.50.1"},"reference-count":26,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:p> The hump-nosed pit viper (HNPV) has historically been considered less medically significant, causing local envenomation, renal injury, and coagulopathy; however, now, it is known to cause life-threatening complications. We describe the clinical presentation, treatment, and complications of 3 confirmed HNPV bites from the state of Karnataka (southwest coastal India). Patient 1, an 88-y-old woman, reported with the live specimen and developed venom-induced consumption coagulopathy (VICC) and thrombotic microangiopathy leading to acute kidney injury requiring blood product transfusions and dialysis. Patient 2, a 60-y-old woman, reported 3 d after envenomation followed by treatment at another hospital where 30 vials of polyvalent anti-snake venom (ASV) were given. She developed VICC and acute kidney injury requiring dialysis. On Day 9 of treatment, she developed a pontine hemorrhage. She died after a transfer to another treatment center closer to her residence. Patient 3, a 25-y-old man, was brought to our emergency department 6 h after being envenomed. He received topical ayurvedic treatment before arrival. He was unconscious and found to have severe VICC with a massive middle cerebral artery infarct. All 3 patients received Indian polyvalent ASV, which does not cover HNPV envenomation, clearly demonstrating the absence of paraspecificity and neutralization in a clinical setting. To our knowledge, Hypnale hypnale envenomation has not previously been reported from Karnataka state. The diagnosis of HNPV envenomation in a country without snake venom detection kits, under-reporting despite serious complications, financial burdens on rural populations afflicted, and poor outcomes due to the lack of a specific antivenom are discussed. <\/jats:p>","DOI":"10.1016\/j.wem.2022.08.006","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T02:29:30Z","timestamp":1665455370000},"page":"399-405","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":17,"title":["Hump-Nosed Pit Viper Envenomation in Western Coastal India: A Case Series"],"prefix":"10.1177","volume":"33","author":[{"given":"Freston M.","family":"Sirur","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jayaraj M.","family":"Balakrishnan","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vrinda","family":"Lath","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2022,12,1]]},"reference":[{"key":"bibr1-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.11646\/zootaxa.2232.1.1"},{"key":"bibr2-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1186\/1678-9199-20-24"},{"key":"bibr3-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2012.10.013"},{"key":"bibr4-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2006.03.008"},{"key":"bibr5-j.wem.2022.08.006","volume-title":"Snakes of India-the Field Guide","author":"Whitaker R.","year":"2016","edition":"2"},{"key":"bibr6-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1580\/06-WEME-CO-023R1.1"},{"key":"bibr7-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.jprot.2013.07.020"},{"key":"bibr8-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.actatropica.2010.11.001"},{"key":"bibr9-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/S1995-7645(11)60147-8"},{"key":"bibr10-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijbiomac.2018.07.016"},{"key":"bibr11-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2013.811589"},{"key":"bibr12-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2018.10.003"},{"key":"bibr13-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2014.11.231"},{"key":"bibr14-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1186\/1477-9560-10-21"},{"key":"bibr15-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2017.05.005"},{"key":"bibr16-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2019.03.015"},{"key":"bibr17-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2017.11.003"},{"key":"bibr18-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.4269\/ajtmh.1994.51.823"},{"key":"bibr19-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.2147\/IJGM.S136153"},{"key":"bibr20-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1186\/s13256-018-1756-2"},{"key":"bibr21-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1155\/2019\/4172395"},{"key":"bibr22-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-015-1426-z"},{"key":"bibr23-j.wem.2022.08.006","author":"Vanuopadath M.","year":"2020","journal-title":"bioRxiv"},{"key":"bibr24-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.wem.2019.12.006"},{"key":"bibr25-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1016\/j.transci.2013.03.006"},{"key":"bibr26-j.wem.2022.08.006","doi-asserted-by":"publisher","DOI":"10.1002\/jca.21691"}],"container-title":["Wilderness &amp; 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