Challenges in managing hump-nosed pit viper envenomation in southern India: a case study

Snakebites are a significant health risk in India, with the 'Big Four' venomous species often overshadowing other deadly snakes like the hump-nosed pit viper (Hypnale hypnale). Despite its increasing recognition for causing severe envenomation, this species remains under-reported and inadequately addressed in treatment protocols. A woman aged in her sixties was bitten by a suspected hump-nosed pit viper while working in the fields. Despite receiving 26 vials of polyvalent antisnake venom, she developed persistent coagulopathy and anaphylaxis, requiring fresh frozen plasma and antibiotics. Coagulopathy and bleeding were controlled by day 5.This case highlights the need for species-specific antivenoms and improved management protocols for envenomation by Hypnale hypnale.