[Viper bites].

The common European adder (Vipera berus) is the only naturally occurring venomous snake in Poland. Adder bites occur mainly in the summer usually to individuals who accidentally or purposely bother snakes. Children often become victims of adders. The most common symptoms are: local swelling, rash and discoloration around the bite. General symptoms such as extensive edema spreading to the trunk, vomiting and diarrhoea, acute renal failure, CNS disturbances and cardiovascular problems are not frequent. Haemorrhages are extremely rare. Shock, although also rare, is the most serious symptom. Fatalities are quite exceptional. The treatment should start first of all with immobilization of the bitten limb and in most cases it will suffice. Any patient suspected of being bitten, should be kept under observation in hospital, where the supportive care is possible, if needed. Antivenoms, thought quite safe nowadays, can be used in case of adults only when all of the other means including intensive shock care have been ineffective. In children early treatment with new more purified antivenoms may be considered however existing literature does not offer evidence based efficiency of such treatment in larger groups of children. Tetanus protection is a routine.