Sri Lanka: Vipera russelli pulchella
Mynamar, Thailand: Daboia russelii siamensis
Taiwan: Viper russelli formosensis
Mechanisms of toxicity:
(1) phospholipase that activates Factor X in the coagulation cascade, which can result in massive clotting and defibrination
(2) daboiatoxin and other toxins producing organ damage
Coagulopathy-related findings may include:
(1) disseminated intravascular coagulopathy (DIC) with defibrination, massive hemorrhage and/or thrombosis
(2) thrombosis or hemorrhage into the pituitary, resulting in hypopituitarism (Sheehan syndrome)
(3) cerebral infarctions, stroke
(4) digital gangrene
(5) hemolytic anemia
Other organ damage:
(1) nephropathy (renal ischemia, glomerulopathy, renal tubular damage)
(2) cardiotoxicity with ventricular tachycardia
(3) hepatocellular necrosis
(4) myotoxicity with myalgia and/or rhabdomyolysis
(5) vasodilation with pulmonary and conjunctival edema
(6) neurotoxicity (seizures, facial palsy, ophthalmoplegia, paresis, dysphagia, etc)
