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Envenomation by the common European adder (Vipera berus)

a case series of 219 patients

Hermansen, Mette N.a; Krug, Andrea H.b; Tjønnfjord, Eirikb; Brabrand, Mikkelb,c,d

doi: 10.1097/MEJ.0000000000000577
Original article: PDF Only

Objectives Every year, several patients are bitten by the common European adder (Vipera berus). The aim of this study is to present a large consecutive case series of patients bitten by V. berus, and to identify signs and symptoms indicative of complicated illness.

Patients and methods This is a retrospective case series from the Hospital of South West Jutland, Denmark. All 219 patients bitten by V. berus (diagnosed by history or clinical findings) from 1994 to 2012 were identified through hospital databases. A severity grading from 1 to 5 was applied, and epidemiology, symptoms and signs, complications, treatment and laboratory data were extracted from the hospital databases.

Results The most common complaints on admission were pain, nausea, abdominal pain, diarrhoea and dizziness, with discoloration and oedema being the most common symptoms. Few patients experienced syncope, palpitations or respiratory distress. Fifteen percent of all patients were transferred to the ICU and 2% (all children) were suspected of having compartment syndrome. Leucocytosis, gastrointestinal symptoms and hypotension were risk factors for complicated disease.

Conclusion Most patients only showed symptoms of no or mild envenomation. Fifteen percent were transferred to the ICU and five patients (all children) required fasciotomy because of suspected compartment syndrome. Only 10 patients received antivenom.

aDepartment of Anaesthesiology

bDepartment of Emergency Medicine, Hospital of South West Jutland

cInstitute of Regional Health Research, University of Southern Denmark, Esbjerg

dDepartment of Emergency Medicine, Odense University Hospital, Odense, Denmark

Correspondence to Mikkel Brabrand, MD, PhD, Department of Emergency Medicine, Odense University Hospital, Sdr. Boulevard 29, DK-5000 Odense, Denmark Tel: +45 791 820 000; e-mail:

Received April 19, 2018

Accepted September 5, 2018

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