A clinical study of viper bite poisoning.

Thirty-one consecutive cases of snake bite were studied in the Benue Valley, Nigeria where carpet viper (Echis carinatus) bite constitutes a serious health problem. E. carinatus was responsible for 26 cases, the night adder (Causus maculatus) for three and the puff adder (Bitis arietans) for two. There were two fatalities, both late admissions following E. carinatus poisoning. One patient died after a subarachnoid haemorrhage and the other after tissue necrosis and the complications of a tightly applied tourniquet. Another fatality after E. carinatus bite was suspected in a patient who discharged himself from hospital after Behringwerke antivenom failed to control bleeding and coagulopathy. Other cases of Behringwerke antivenom's failure and of slow response to treatment confirmed the pressing need for a more effective Echis antivenom in West Africa. The enzyme-linked immunosorbent assay (ELISA) was used for diagnosing the biting species and was the only means of identifying the three cases bitten by C. maculatus and one case bitten by B. arietans.