immediate sharp pain occurs secondary to the adder bite
after a period of time (generally within a few minutes but sometimes up to more than 30 minutes later) there is a sensation of tingling and local swelling that spreads proximally
uncommon for local blisters containing blood to occur at the site of the adder bite
within hours of the adder bite there is occasionally a spreading pain, tenderness, inflammation, and tender enlargement of regional lymph nodes - this process is often described as "cellulitis" but this is misleading because there is no infection (1)
the whole limb affected by the adder bite may become bruised and swollen within 24 hour; there also may be generalised swelling and bruising secondary to an adder bite in children
intracompartmental syndromes and necrosis are very rare
Systemic features:
anaphylaxis may occur
may appear within five minutes of the bite or may be delayed for many hours
possible systemic features include nausea; vomiting; abdominal colic; diarrhoea; faecal incontinence; urinary incontinence; sweating; fever; vasoconstriction; tachycardia; hypotension (this is often the most critical sign and generally develops within the first few hours following the adder bite and may spontaneously resolve, persist, recur or progress with fatal consequences); loss of consciousness; shock; angiooedema; urticaria; and bronchospasm
features may persist or fluctuate for as long as 48 hours in the absence of treatment
a bleeding diathesis is unusual - however bleeding from various sites (including the gums and nose, lungs, gastrointestinal and genitourinary tracts, and serosal cavities and retroperitoneum) can occur
risk of bleeding is greatly increased by inappropriate treatment with heparin
rare systemic features include haemothorax, massive upper gastrointestinal bleeding, haematuria, and intrauterine fetal death
acute renal failure may occur - this has particularly been reported in adder bites in children
generalised oedema may occur
occurence of coma and seizures may occur secondary to profound hypotension, cerebral oedema, hyponatraemia, hypoalbuminaemia, or hypoxaemia secondary to respiratory distress
rare systemic complications that have been reported include cardiac arrest, acute pancreatitis and paralytic ileus
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