[Aggravation of snake bite in France and their treatment]

VIPERS AT THE ORIGIN OF ENVENOMING: Out of the 4 species of vipers found in France, only two can be responsible for severe envenoming: the aspic viper (Vipera aspis) and the addetr (Vipera berus). CLINICAL GRADING: Since 1992, a grading table published by the Institut Pasteur in Paris helps to assess the severity of the clinical and biological picture. A grade 2 (extensive oedema +/- accompanied by moderate general signs) or notably a grade 3 (giant oedema + severe general signs + biological signs) implies the administration of an antivenom. ANTIVENOM VIPERFAV: Available on the market since 2000, is administered in intravenous infusion, the only route effective. Tolerance to the treatment is good and clinical improvement is rapid after administration of 1 to 4 infusions of antivenom. When confronted with life-threatening envenoming, there is no strong argument to justify the non-use of an antivenom. VIPERINE ENVENOMING: Among the grass snakes, the viperine snake of Montpellier is the only species that is actually venomous. The fangs are posterior in the buccal cavity of the snake, which does not usually permit it to inject its venom in humans. In exceptional circumstances (finger placed in the throat), envenoming has been observed with, in this case, essentially neurological clinical signs: involvement of the cranial nerves, drowsiness. There is no specific treatment for these extremely rare accidents.