A snake bite by the Burrowing Asp, Atractaspis engaddensis

During routine milking of a group of Burrowing Asps Atractaspis engaddensis, one of the authors was bitten in the index finger by one fang, as is characteristic of bites by snakes of the genus. Local effects, oedema, erythema and numbness appeared within minutes, followed by systemic effects, including general weakness, sweating, pallor, fluctuations in the level of consciousness, vomiting and watery non-bloody diarrhoea. Gross oedema of the hand developed and extended up to the forearm. Two hours after admission to the hospital, blood pressure rose to 180/110, the ECG showed normal sinus rhythm and no signs of atrioventricular conduction block. An ECG obtained 24 h after the bite showed new T-wave inversions in leads V5 + 6, which gradually returned to baseline within several days. The local effects healed during the following weeks, but some discoloration and tenderness remained even 10 months after the bite. A maximal exercise (SPECT) study carried out five months after the bite was normal and a multigated radionuclear ventriculogram (MUGA) showed normal left-ventricular function. It may be assumed that the rise in blood pressure observed in this case reflects a systemic vasoconstrictive effect of the sarafotoxins, while the ST changes may have been caused by the direct effect of the toxins on the heart or indirectly by vasoconstriction of the coronary arteries. However, ischaemia secondary to a rise in blood pressure or to excitement could also explain the observed ECG-changes.