Bleeding manifestations in snake bite

Bleeding following bites by the Malayan Pit Viper can either be local or systemic. Bleeding at the site of the bite is due to the local action of the venom as a vasculotoxin. Systemic bleeding occurs with severe poisoning and appears to be mainly dependent on platelet deficiency and the co-existing defibrination syndrome appears to play a minor role in the initiation of bleeding. Thus in the clinical situation non-clotting blood with no overt bleeding can continue up to weeks when specific antivenene is not given. Assessment of the severity of poisoning can easily be made at the bedside. Specific viper antivenene rapidly corrects the spontaneous bleeding and clotting defect of severe systemic poisoning but has no effect on local poisoning.