Envenimations ophidiennes graves

Snakebites are an underestimated public health problem, affecting mainly sub-Saharan Africa and South Asia. In France, while the prevalence is low, the keen interest for exotic pets increases the risk of severe envenomation by exotic species. Mostly due to viperidae, viperin syndrome associates haemostasis disorders and local syndrome (pain, swelling and necrosis). The haemostasis disorders are due to venom-induced consumption coagulopathy (VICC) that is different from disseminated intravascular coagulation; and cause local and diffuse bleedings. The elapidae are responsible for cobraïc syndrome, resulting from the action of neurotoxins and respiratory paralysis. Other syndromes include: circulatory failure, acute renal failure, cardiotoxic and myotoxic damage. These syndromes can be associated into a multimodal clnical syndrome. Ophidian envenomation is a real medical emergency, requiring sometimes resuscitation in the field (fluid resuscitation, oro-tracheal intubation and artificial ventilation). Hospital admission must be systematic in order to administer antivenom, the only etiological treatment, that is used according to a severity score. Combination with fresh frozen plasma allows to more rapidly stop VICC. In contrast, heparin is not indicated during the acute phase.