Unfortunately, snakes remain a nightmare for the villagers in Lebanon. Ninety percent of snakebites are non-venomous, and snakes are not aggressive and do not bite unless provoked. Among the 25 species that were observed in Lebanon, only three were identified as venomous snakes: vipera palaestinae, vipera lebetina and vipera bornmuelleri. The objectives of this article are to present the types of Lebanese snake species, and to provide a guide for management in the emergency department and the indications for antivenom use. Finally, we will present common misconceptions and the Lebanese situation concerning antivenom availability.
Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008; 5:e218.
Zahran Th, Kazzi Zi, Chehadeh Ah, Sadek Ri, El Sayed Ma. Snakebites in lebanon: a descriptive study of snakebite victims treated at a tertiary care center in Beirut, Lebanon. J Emerg Trauma Shock 2018; 11:119-24.
Alirol E, Sharma SK, Bawaskar HS, KuchU, Chappuis F. Snake bite in South Asia: a review. PLoS Negl Trop Dis 2010; 4:e603.
Warrell D. Snakes of medical importance (Asia Pacific region). Singapore: Venom and toxin research group, National University of Singapore 1990.
Warrell DA. WHO Guidelines for the clinical management of snake bites in the South East Asia Region. SE Asian J Trop Med Publ Health 1999; 30:1-83.
Currie BJ. Treatment of snakebite in Australia: the current evidence base and questions requiring collaborative multicentre prospective studies. Toxicon 2006; 48:941-56.
Arnold EN, Burton JA. A field guide to the reptiles and amphibians of Britain and Europe. London: Collins Field Guide 1978. 272 pp.
McDiarmid RW, Campbell JA, Touré T. Snake species of the world: A taxonomic and geographic reference. Herpetologists’ League 1999. 511 pp.
Mallow D, Ludwig D, Nilson G. True Vipers: Natural history and toxinology of old world vipers. Malabar, Florida: Krieger Publishing Company 2003. 359 p.
Segev G, Shipov A, Klement A, Harrus S, Kass P, Aroche I. Vipera palaestinae envenomation in 327 dogs: a retrospective cohort study and analysis of risk factors for mortality. Toxicon 2004; 43:691-9.
The reptile database. Macrovipera lebetina. Linnaes 1758; Available from: www.reptile-database.org (Last access 07/11/2019).
Al Oran R, Rostum R, Joger U, Amr Z. First record of the Levantine Viper, Macrovipera lebetina, from Jordan. Zoology in the Middle East 1998; 16:65-70.
Siigur J, Aaspo A, Nismägi K. Proteases from Vipera lebetina venom affecting coagulation and fibrinolysis. Haemostasis 2001; 31:123-32.
The reptile database. Montivipera bornmuelleri. Werner 1898; Available from: www.reptile-database.org (Last access 10/12/2019).
Accary C, Rima M, Kouzayha A, Hleihel W, Sadek R, Desfontis J, et al. Effect of the Montivipera bornmuelleri snake venom on human blood: Coagulation disorders and hemolytic activities. Open J Hematol 2014; 5:1-9.
The university of Melbourne. Pressure immobilisation bandaging (PIB): Applying a pressure immobilisation bandage. Available from: http://www.avru.org/firstaid/firstaid_pib.html (Last access 07/11/2019).
Christensen PA. The stability of refined antivenin. Toxicon 1975; 13:75.
Alberts M, Shalit M, LoGalbo F. Suction for venomous snakebite: a study of «mock venom» extraction in a human model. Ann Emerg Med 2004; 43:181.
White J. Overview of venomous snakes of the world. In: Medical Toxicology, 3rd edition, Dart RC (Ed), Lippincott, Williams, & Wilkins, Philadelphia 2004. 1543 p.
Gloaguen A, Pouessel G, Cesareo E, Vaux J, Valdenaire G, Ganansia O, et al. Management of anaphylaxis in emergency medicine. Med Emergency, MJEM 2016; 25:4-24.
Fernando P, Dias S. Indiankrait bite poisoning; Ceylon Med J 1982; 27:39-41.
Rahmani AH, Jalali A, Alemzadeh-Ansari MH, Tafazoli M, Rahim F. Dosage comparison of snake anti-venomon coagulopathy. Iran J Pharm Res 2014; 13:283-9.
Narvencar K. Correlation between timing of ASV administration and complications in snake bites. J Assoc Physicians India 2006; 54:717-9.
Polyvalent Snake Antivenom. National Antivenom and Vaccine Production Center; 2015. Available from: http://antivenom-center.com (Last access 10/12/2019).