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Snakebite and snake envenoming in Europe is uncommon and the most important group of venomous snakes are Vipera spp.

Table 1: Severity grading for European viper (Vipera spp.) envenomation based on the modification by Boels et al.1
Grade
Severity
Clinical Features
Venom concentrations
0
Not envenomed
No local reaction or edema. Fang marks may be present.
< 5ng/ml
1
Minor envenoming
Local edema at the bite site. No systemic effects.
< 5ng/ml
2a
Moderate envenoming
Regional swelling and edema (most of the bitten limb) and/or hematoma; enlarged lymph nodes
7ng/ml (0 to 15)
2b
Moderate envenoming
Systemic symptoms (vomiting, diarrhoea, abdominal pain)
Mild hypotension (systolic BP<90mmHg) not requiring treatment
Hemotological abnormalities: white cell count > 15 x 10-9; platelets < 150 x 10-9; fibrinogen < 2g/l; INR > 1.5
Evidence of neurotoxicity
7ng/ml (0 to 15)
3
Severe envenoming
Extensive edema spreading to the trunk; severe hypotension/shock (systolic BP<80mmHg), bleeding
23ng/ml (10 to 35)
INR – international normalised ratio;