Pathophysiology and Treatment of Envenomation by European Vipers

  • Hans Persson
Reference work entry
Part of the Toxinology book series (TOXI)


Significant envenoming caused by European snakes is related to bites by species belonging to the family Viperidae, genus Vipera. The most common vipers in Europe are Vipera berus berus, Vipera aspis, and Vipera ammodytes. Vipers living in more restricted areas are, e.g., Vipera latastei, Vipera xanthina, Vipera lebetina, Vipera ursinii, Vipera berus bosniensis, and Vipera palaestinae. The venom of European vipers may cause anything from mild to severe and sometimes life-threatening reactions. Envenoming related to bites by European vipers may cause severe systemic symptoms and extensive local tissue damage. The symptoms caused by the different European vipers are rather similar, but there are a few important differences. Bites in the extremities result in local swelling and hemorrhagic discoloration. Parts or the whole of the bitten extremity might become affected, but the swelling may also gradually involve large parts of the trunk. The severity of the envenoming is related to the amount of venom injected and the age of the patient. Small children are more vulnerable as a certain dose becomes more noxious the smaller the victim is. Common systemic symptoms are abdominal pain, vomiting and diarrhea, hemodynamic instability, CNS depression – even coma and seizures have been observed in small children – and anemia that may become pronounced and require blood transfusions. Leukocytosis is common and if pronounced it may be a sign of severe envenoming. Also thrombocytopenia may occur. Some southern European vipers, e.g., Vipera aspis and Vipera berus bosniensis, may also cause neurological symptoms. A recent publication indicates that neurotoxicity also may develop after bites by Vipera ammodytes. Treatment of bites by European vipers includes both symptomatic care and specific therapy with antivenins. In Europe both equine and ovine antivenins are available. Vipera berus berus is considered to have the most widespread geographical distribution of all venomous snakes.


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© Springer Science+Business Media B.V., part of Springer Nature 2018

Authors and Affiliations

  1. 1.Swedish Poisons Information CentreStockholmSweden

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