Abstract

Hump-nosed viper (Hypnale hypnale; HNV) is one of the six major snake species in Sri Lanka that cause envenomation. Nephrotoxicity, coagulopathy, and neurotoxicity are wellrecognized features of its envenomation. Type 4 renal tubular acidosis (RTA4) has only once been described previously in this condition, and we report two further cases. Two patients aged 53 and 51 presented following HNV bites with acute kidney injury and microangiopathic hemolytic anemia. Both underwent multiple cycles of hemodialysis until the polyuric phase was reached. Despite polyuria, both patients developed resistant hyperkalemia that needed further hemodialysis. The urinary pH, arterial pH, delta ratio, and transtubular potassium gradient confirmed RTA4. HNV venom has been shown to damage the proximal convoluted tubules in animal studies, but not the distal convoluted tubule, and hence the mechanism of our observation in these two patients is unclear. Unexplained hyperkalemia in recovery phase of HNV bite should raise suspicions of RTA4.

Details

Title
Transient distal renal tubular acidosis following hump nosed viper bite: Two cases from Sri Lanka
Author
Weerakkody, Ranga; Lokuliyana, Pushpa; Lanerolle, Ruchika
Publication year
2016
Publication date
Sep-Oct 2016
Publisher
Medknow Publications & Media Pvt. Ltd.
ISSN
13192442
e-ISSN
23203838
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
1839148609
Copyright
Copyright Medknow Publications & Media Pvt Ltd Sep-Oct 2016