Death from poisoning of snake venom, as a result of a viper’s bite

Aspect of poisoning after a black adder’s bite can be very various (from the absence of clinical picture of poisoning to the mortal case) and unforeseeable in its progress. Poison of black adder is more toxic in comparison with Orsini’s viper, the death after a black adder’s bite comes approximately in 1% cases. Unpredictability of consequences of such bite depends on such objective factors as: weight of the injured person’s body (the reaction is more severe for children); state of health (presence of co¬existing diseases); places of bite (the most dangerous bites are considered in head or neck and discovering of poison in cutaneous vein); size of snake (the larger snake has more poison); amount of the entered poison (a viper produces a poison gradually, and if a poison is used by it recently, a bite can be absolutely safe «dry bite». In the spring time the viper’s venom is more toxic than in the summer time. Composition of the viper’s venom contains the enzyme components, winch form a clinical aspect of poisoning substantially by these poisons, The proteases of vipers’ poison cause the local damage of tissues, zonal hemorrhoidal edema, myonecrosis, as well as have fibrogenic, fibrinolytic, coagulating and bradykinin liberatoral actions. The proteolytic enzymes of poisons can be divided into two groups: serine proteases and metalloproteases. Serine proteases are thermolabile endopeptidases, having a kind of action similar to thrombin enzymes of takininogenases. The second group of proteases of the snake venom contains thermolabile proteins, which hydrolyze protein substrates (casein, haemoglobin, insulin etc.). Activity of these metal!oproteases appears in the presence of bivalent metals. In this case a citizen A., born in 1938, asked for medical assistance to the district hospital on May 3, 2016 at 15.20 with complaints of pain in the left lower limb in the place of a bite, a pain at the back of a breastbone, general weakness, dizziness, nausea, common cold. She considers itself as diseased woman during about two hours, when she was bitten by the unknown animal (snake) during work on a vegetable garden. She felt a sharp pain in the left foot. She was examined by a doctor: on the dorsum of the left foot there is the «place of a bite» with a diameter of 0,2 cm. A foot was swollen, hyperaemic, and hot. The size of hypodermic haematoma is 7x5 cm. The patient has unstable hemodynamics, permanent nausea. Antitoxic therapy, antishock therapy, hormonal preparations, preparations against vomit were assigned for the patient. Biological death of the patient came at 4 hours. It is necessary to note, that in her lifetime the patient had an ischemic heart trouble, hypertensive illness. At carrying out of medical and legal expertise of dead body, at external investigation it was discovered: hypodermic hemorrhage of violet color, oval form, with the size of 17x11 cm on the dorsum of the left foot, on a background the edema of soft tissues, from fingers to the limit of bottom third of the left shin. On a background the above mentioned hypodermic hemorrhage in the projection of instep bone of the first finger of the left foot on a back-internal surface it is discovered a two wounds of the rounded form with even edges, having a diameter of 0,2 cm, spread to wound canals. A liquid flows from the clearance of wounds of dark-red blood . At dissection of soft tissues, muscles were saturated with a blood, divided into layers. It is discovered a liquid blood in layers. At internal research there were signs of rapid death coming (head cerebral and lungs edema, hyperemia of the inward parts of the body, dark-red blood in the cavities of heart and large vessels, hemorrhages of dark-red colour under the pleura of lungs and epicardium of heart). Results of histological research: imposition of blood on an epidermis, hemorrhagein all layers of derma and to the hypodermic-fatty cellulose in soft tissues in the area of a bite, consisting of partly laky red corpuscles. Leukostasis in vein, dissection and homogenization of vascular walls, edema and homogenization of tissue. In kidneys on a background of anaemia of cork substance it is discovered the centre of venous plethora of tissue, erythrocytic sludged blood in venules, albuminous degeneration of the twisted channels. It is discovered the irregular blood filling of tissues. Taking into account macro- and microscopic picture of changes in organs and tissues, circumstances of the case it may be concluded that the victim’s death occurred from the action of the snake’s venom.