From Big Medical Encyclopedia

SNAKE POISON — specific poisonous secret of special parotid glands of some species of snakes. Glands cosecreting poison are connected by channels to channels of two poisonous teeth of an upper jaw from where poison at a snake bite gets into a body of the victim and causes poisoning (see. Snakes ).

Structure and properties

3. I. — viscous, colorless or inodorous yellowish liquid, with bitterish taste. Reaction its subacidic, ud. weight 1,030 — 1,090. In the liquid state it low-racks, easily rots and in 10 — 20 days loses toxicity and many fermental properties. Well dried up poison (eksikatorny, freeze or vacuum drying) loses more than 3/4 initial weights and turns into the whitish-yellow kristallopodobny powder keeping the main properties of poison for many years. Dry 3. I. it is dissolved in water, chloroform, salt solutions.

Main component 3. I. — proteins and peptides to which share falls apprx. 80% of its dry weight. They are carriers of the main toxic and fermental properties of poison. In addition, in 3. I. the free amino acids, nucleotides derivative of guanine, mucin, sugar, lipids, pigments, inorganic salts, and also impurity from an oral cavity of a snake (epithelial cells, bacteria) contain.

Many poisons and their fractions are studied on elementary and amino-acid structure. It is established that toxicity and some fermental properties 3. I. give disulfide groups. Glutathione and other reducers of these groups reduce toxicity of poisons of a cobra, Russell's viper, rattlesnake by 80 — 90%, almost completely eliminating at the same time their coagulant action on blood and fosfolipazny activity of the last two poisons.

Biologically active beginnings of poisons divide into three groups: 1) highly toxic thermostable polypeptides, or the low-molecular proteins deprived of fermental properties; 2) the krupnomolekulyarny proteins-enzymes having high toxicity; 3) the proteins having various fermental properties, but deprived of the expressed toxicity. Some of enzymes of the last group can exponentiate effect of the main toxins 3 directly or indirectly. I.

The toxins of the first group which are generally relating to neurotoxins contain in poisons of adders, sea serpents, some tropical rattlesnakes of South America and in poison of only one representative of gadyukovy — the Palestinian viper. At the majority of adders and sea serpents these neurotoxins are presented by the main polypeptides about a pier. it is powerful apprx. 6000 — 7000, consisting of 61 — 62 amino-acid remains in one chain with four cross disulfide bridges, at snakes of p. Bungarus — larger polypeptides (71 — 74 amino-acid the rest with five disulfide bridges), at the Palestinian viper — from 108 amino-acid remains with three disulfide bridges. Krotoksin — the most powerful neurotoxin found in poison of a rattlesnake of Crotalus durissus terrificus — represents complex connection of a phospholipase A2 and low-molecular polypeptide, in a complex with to-rymi a phospholipase of A2 gets a high neurotoxicity, losing substantially the fermental properties.

In poisons of some adders (a cobra, etc.) also the polypeptides possessing cardiotoxic and cytolytic action are found. Low-molecular toxin of tropical gremuchnik — krotamin is close to them. Lethal action of Cardiotoxinum of poison of a cobra is 20 times weaker, than a neurotoxin.

In poisons of the majority gadyukovy and rattlesnakes, including all vipers and shchitomordnik of fauna of the USSR, low-molecular neuro and Cardiotoxinums do not come to light. Effective agents of poisons of these snakes the thermolabile and not dialyzing through semipermeable membranes proteins with high protease activity, hemorrhagic, necrotizing and the action curtailing blood.

The composition of poisons of a number of the Australian adders and some tropical gremuchnik is more complex; in them both not fermental neurotoxins, and powerful proteases of hemorrhagic and haemo coagulating action are found.

On composition of the main toxins and on the leading displays of intoxication 3. I. can be subdivided into the following basic groups: 1) with dominance neuro and Cardiotoxinums (poisons of adders, sea serpents and some tropical gremuchnik); 2) with dominance of toxic proteases of the hemorrhagic, necrotizing and curtailing blood action (toxins gadyukovy and the majority of rattlesnakes); 3) poisons of the mixed structure, the neurotoxins, and powerful enzymes containing both hemorrhagic and curtailing blood of action (toxins of a number of the Australian adders and tropical rattlesnakes).

3. I. it is rich with enzymes, many of which are unique on the mechanism and force of action. In it proteases (ekzo-and endopeptidases, etc.), phospholipases, acetylcholinesterases, hyaluronidase, phosphatases (fosfomono-and diesterases, etc.), nucleotidases, oxidases, dehydrogenases, catalases and other enzymes are found. Related enzymes of different poisons differ on the mechanism of action. So, to the Agul elements in one poisons turn fibrinogen into fibrin (trombinopodobny effect), in others — activate a factor of X (tromboplastinopodobny effect), in the third — turn a prothrombin into thrombin etc.

In snake poisons there are also inhibitors of fermental systems, including inhibitors of tissue respiration (tsitokhromoksidazny system, a succinatedehydrogenase, enzymes of anaerobic glycolysis), anticoagulants, etc.

Statistics of poisonings

According to the incomplete data published by WHO, the annual number of the people who were injured from stings of venomous snakes makes on the globe apprx. 500 thousand, from them 30 — 40 thousand (6 — 8%) perish. More than 4/5 all cases are registered in Asia, Africa and South America. Only in India the number of victims reaches 100 thousand people a year.

In process of removal from tropics the frequency and weight of stings of venomous snakes decrease. In the USA the annual number of victims of snake stings hesitates, according to different authors, from 1,2 to 3,7 on 100 000 inhabitants. However yuzh. and South zap. states on these indicators approach the tropical countries:

10,8 — 18,8 on 100 000. In Western Europe and in a midland of the USSR the frequency of snake stings is lower, than in general across the USA (no more than 0,7 on 100 000), on Yu. Central Asia and it increases in Transcaucasia by 2 — 3 times. After implementation of modern methods of treatment the lethality sharply decreased: in Brazil — from 27 to 8%, in the south of Japan — from 15 to 3%, in the USA — from 3,05 to 0,21% etc. Stings of the most dangerous snakes of subtropical fauna of the USSR (a gyurza, a sandy efa) in the past gave apprx. 8% of lethal outcomes, this indicator is lowered almost to zero.

Degree of snake danger (ophidiasis) in each this area is defined as the number and species composition of venomous snakes, and social demographic factors (population density, degree of its urbanization, feature of life, clothes and so forth).

Degree of danger of stings of various venomous snakes of fauna of the USSR is characterized by the following data: in Tajikistan at stings of a gyurza extremely severe form of poisoning was observed in 8,1% of cases, heavy — in 40,4%, moderately severe — in 27,4%, easy — in 24,1%; in Altai Krai at stings of a viper ordinary extremely severe form of poisoning was not noted, heavy — was observed in 6,4% of cases, moderately severe — in 36,2%, easy — in 57,4%.

A pathogeny and clinic of poisonings

the Pathogeny and features a wedge, manifestations at poisoning 3. I. are defined first of all by composition of poison — the preferential maintenance in it of neurotoxins, neurocardiotoxinums or hemorrhagic coagulants. At the same time at stings even weight of intoxication varies the most dangerous snakes. The dose and concentration of the emitted poison have crucial importance. As well as secrets of other glands, 3. I. it is allocated in more, in less concentrated look, and the amount of the poison getting to an organism of the victim can fluctuate from 0,4 to 65% of its general stock.

Weight of intoxication depends also on age and the state of health of the victim, on localization of a sting and on to what fabric poison got. Children, especially aged up to 3 years, have poisoning much heavier, than adults; stings in the head and a trunk it is more dangerous, than in an extremity, and hit of poison directly in a blood vessel can cause death of the victim in 5 — 10 min. after a sting. Intramuscular hit of poisons of vipers and rattlesnakes is almost twice more dangerous, than hypodermic, and intramuscular hit of poison of an adder gives the same effect, as hypodermic.

Damages poisons of preferential neurotoxic action

Neurotoxic action are caused by poisons of adders and sea serpents (in the USSR — only poison of the Central Asian cobra), Neurotoxic — poisons of some tropical gremuchnik.

Poisons of adders and sea serpents block neuromuscular and interneural synapses, raise, and then suppress excitability touch and chemoceptors, oppress bark, the subcrustal and trunk centers of c. N of page. Symptoms of defeat develop quickly since neurotoxins 3. I. easily come from fabrics to a blood stream. At the same time these toxins are quickly removed from an organism, appearing in a large number in urine in 13 — 20 min. after administration of poison, and in the subsequent 16 hours they are almost completely excreted.

Clinically intoxication is shown by various touch disorders, a prematurity of lacks of coordination of movements and flaccid paralyzes, disorders of consciousness (a sopor, a coma), and in hard cases — the accruing respiratory depression up to its stop. The apnoea is caused not only by paralysis of respiratory muscles (kurarepodobny effect), but also oppression of a respiratory center.

Disturbances of blood circulation have phase character. The first 15 — 20 min. the shock caused by intensive receipt from fabrics in a blood stream of a histamine and then the oppressing effect of poison on a vasomotor center develops. In 1 — 2 hour of the ABP it is normalized or even increases above initial. In 6 — 12 hours cardiotoxic effect of poison can be shown: there is arrhythmia, atrioventricular blockade, systolic and minute volumes of heart progressively decrease, cardiogenic shock, sometimes a fluid lungs develops. At a serious poisoning the neurotoxic effect advances cardiotoxic, and death comes from paralysis of breath.

The clinic of poisoning with poison of the Central Asian cobra is a little studied because of an extreme rarity of stings by this snake. The available single observations show that it qualitatively does not differ from a picture of poisoning with poison of the Indian cobra. At once after a sting a snake victims have an acute pain in a zone of defeat extending to all affected extremity and to other parts of a body. In a few minutes develop the progressing general weakness, an adynamia, then feeling of numbness in extremities, a trunk and in the person, the general constraint. Coordination of movements is broken, and in 20 — 30 min. the patient loses ability to move and stand on the feet independently. During the same period initial signs appear collapse (see). Then quickly paresis, and in hard cases — full paralysis of muscles of extremities, trunks progresses (see. Paralyses, paresis ), and also persons, language, a throat and an organ of sight that conducts to aphasias (see), aphonias (see), diplopias (see), to disturbance of swallowing. Disturbances of sensitivity are various: diffuse pain with a skin hyperesthesia and paresthesias (see) are combined with feeling of constraint, numbness, sharp easing of sensitivity and proprioception. Body temperature increases to 38 — 39 °, cardiac sounds are muffled, premature ventricular contraction is possible. The most terrible symptom of poisoning — the progressing oppression and an urezheniye of breath. The threat of death from an apnoea is especially big in the first 2 — 10 hours of poisoning. Then changes from heart progress: dullness of tones, decrease in a voltage of teeth ECG, premature ventricular contraction, atrioventricular block of the I—II degree. Late cardiogenic shock and a fluid lungs are possible.

Local changes in a zone of a sting at defeats by adders and sea serpents it is insignificant are small: two points of a puncture of skin teeth of a snake and insignificant puffiness around them are visible. The hyperemia, hemorrhages, the hemorrhagic hypostasis, bubbles, lymphadenitis and a vein thrombosis inherent in poisonings with poisons gadyukovy and rattlesnakes, never happens that has differential and diagnostic value.

At the favorable course of intoxication all nevrol, frustration in 2 — 5 days are exposed to involution, but muscular weakness, numbness and the aching extremity pains, dullness of cardiac sounds can remain within several weeks.

At poisonings with neurotoxic poisons of tropical rattlesnakes paralysis of breath does not develop, paresis of muscles is combined with convulsive twitchings, even convulsions; in a pathogeny and a wedge, a picture of intoxication the phenomena of heavy shock prevail.

Defeats by poisons with preferential hemorrhagic and curtailing blood action

These damages are caused by poisons of the majority gadyukovy and rattlesnakes, including toxins of all vipers and shchitomordnik of fauna of the USSR.

In a pathogeny of intoxication local destruction of fabrics and edematous and hemorrhagic reaction to poison, system increase in vascular permeability, the general hemorrhagic phenomena, the disseminated intravascular blood coagulation with the subsequent development hypo - or afibrinogenemiya (a trombogemorragichesky syndrome), a hypovolemia, shock, acute posthemorrhagic anemia and dystrophic changes in parenchymatous bodies dominate.

Local changes in a zone of administration of poison are sharply expressed, quickly progress and in many respects define degree of the general intoxication. The first minutes after the snake bite causing small pain and burning sensation around an injection site of poison there are a hyperemia, multiple hemorrhages and quickly extending hemorrhagic hypostasis. At severe forms of poisoning hypostasis and multiple spotty hemorrhages take all affected extremity and quite often extend far to a trunk. The extremity gets crimson and cyanotic coloring, on skin bubbles with serous and hemorrhagic contents can appear, often arise limfangiit, lymphadenitis and thrombosis of the taking-away veins. This reaction reaches the maximum development in 8 — 36 hours after inoculation of poison when the volume of the affected extremity sharply increases and defined plentiful hemorrhagic treatment of all soft tissues. Exudate on a gematokritny indicator, the maintenance of erythrocytes, hemoglobin and protein differs from whole blood a little. Thus, in the struck part of a body there is a huge decrease from a vascular bed of blood that substantially defines development of a hypovolemia, shock, hypoproteinemia and anemia. Wounds on site of a sting sometimes long bleed; later here ulcerations and necroses which emergence is promoted by the wrong rendering first aid to patients can be formed (applyings a tourniquet, cauterizations of the place of a sting etc.).

In an overall picture of intoxication the phenomena of shock prevail: weakness, dizziness, pallor of integuments, nausea, vomiting, sometimes repeated unconscious states, small and frequent pulse, decrease in the ABP. At early stages of intoxication (within the first hour) shock is connected generally with receipt in a blood stream of a histamine and other shockogenic substances, and also with the disseminated intravascular blood coagulation (hemocoagulative shock), and is later with plentiful internal krovo-both plazmopotery and a hypovolemia (posthemorrhagic shock). Coagulability of blood the first 30 — 90 min. sharply increases; are noted adjournment of fibrin in capillaries and multiple microfibrinferments. Then there comes the long phase of hypocoagulation with the expressed hypofibrinogenemia and bleeding (nasal, went. - kish. bleedings, a hamaturia, hemorrhages in bodies, covers of a brain, serous covers, etc.). The Trombogemorragichesky syndrome lasts 1 — 3 day and is followed by signs of acute posthemorrhagic anemia (see).

At easier forms general and toxic symptoms are expressed poorly, local edematous and hemorrhagic reaction to poison prevails. Defeats of an organism poisons of hemorrhagic action quite often are complicated by formation of necrotic ulcers in a zone of a sting and gangrene of the affected extremity that distances terms of recovery and can lead to an invalidism of a part of victims. In uncomplicated cases recovery occurs in 4 — 8 days after a snake bite.

Treatment and prevention of poisonings

At first-aid treatment by the victim are categorically contraindicated banners of the affected extremity a plait, cauterizations of the place of a sting gunpowder, to-tami, alkalis, the boiling oil, etc., local injections of strong oxidizers (potassium permanganate, etc.). All these methods not only do not weaken and effects of poison do not detain, and, on the contrary, considerably strengthen as the general, and local displays of intoxication, promote emergence of a number of heavy complications (necrotic ulcers, gangrene, etc.).

First-aid treatment should be begun with immediate vigorous suction of the contents of wounds allowing to remove as from 28 to 46% of all poison entered into an organism are proved experimentally and clinically. If wounds dried up, previously «open» them pressing on a fold of skin. Suction can be made a mouth (got on the unimpaired mucous membranes 3. I. does not cause intoxication) or by means of a rubber pear, a milk pump etc. It is necessary to continue it 15 — 20 min. (the first 6 min. is removed apprx. 3/4 everything the extracted poison) then wounds process tetraethyl-diamino-triphenyl-carbohydride sulfate, iodine or alcohol. At first-aid treatment the affected extremity is immobilized and provide to the victim absolute rest in horizontal position that reduces outflow of a lymph, toxiferous, from the struck part of a body.

Are useful plentiful drink (tea, coffee, broth). Alcohol intake in any kind is contraindicated. From medicines appoint antihistamines, drugs of sedative action and influencing a vascular tone.

Bystry delivery of patients in the next is important to lay down. establishment where the earliest therapy immune mono - and the polyvalent antitoxic serums (AS) — an antigyurza, an antiefa is possible, an anti-cobra, etc. Treatment is carried out by the general rules serotherapy (see). At severe forms of poisoning the dose of PS makes from 80 to 130 ml and more, at moderately severe poisonings — 50 — 80 ml (M. N. Sultanov, 1963, etc.).

Enter PS intramusculary, and only at extremely serious poisoning and late delivery of patients according to vital indications introduction of one its dose intravenously is admissible. Use homologous PS, however in view of similarity of an antigenic structure of poisons of the snakes belonging to one sort also cross use of PS is admissible. So, serum of an antigyurz can be applied also at stings of other vipers of our fauna (except defeats by poison of the sandy efa belonging to other sort this. gadyukovy). Treatment of PS can be complicated by allergic reactions — a small tortoiseshell, a Quincke's edema, serumal encephalitis, a heavy acute anaphylaxis (according to Campbell, 3% of cases), etc. Therefore the serotherapy, as a rule, should not be applied at stings of ordinary and steppe vipers, shchitomordnik and other low-dangerous snakes at which bystry treatment can be reached by pathogenetic and symptomatic means. Even at stings of a gyurza resort to introduction of PS not in all cases. PS concentrated and cleared of ballast proteins are more effective and are a little less dangerous, than native. For the prevention and weakening of complications of a serotherapy recommend to enter along with PS injured intravenously glucocorticoids (a hydrocortisone, Prednisolonum, etc.), antihistamines and to make hemotransfusions.

Pathogenetic therapy depends on a type of the poison which got to an organism. At defeats by poisons hemorrhagic - coagulative action are most effective and quickly massive jet, and then drop hemotransfusions and plasmas, and also blood substitutes improve a condition of patients. At a serious poisoning in the first days enter 800 — 1500 ml of haemo drugs, in the next days — on 200 — 600 ml. At more slight poisonings and at treatment of children of a dose reduce by 2 — 4 times. For the rest treatment is carried out by the general rules of therapy of posthemorrhagic shock (see). Symptomatic therapy includes purpose of anti-inflammatory drugs, antibiotics of a tetracycline row, antihistamines, antianemic drugs.

Pathogenetic therapy of poisonings with neurotoxic poisons of adders (cobra) and other snakes consists in use along with PS of antishock drugs and in case of approach of paralysis of breath — devices for an artificial respiration. The last method is very important since pharmakol, stimulators of breath do not warn and do not stop paralysis of the breath caused by poison of a cobra.

At stings of snakes of all types preventive administration of antitetanic serum is necessary.

Individual prevention of stings of venomous snakes is provided with protection of extremities high leather footwear and dense clothes, careful survey of places of parking or a lodging for the night. Usually snakes are not aggressive and bite only as self-defense therefore the persons trying to catch or kill a snake are exposed to stings generally, children and teenagers are more often. In this regard explanations of danger of prosecution of snakes are necessary; nonspecialists, especially teenagers shall not be involved in catch of venomous snakes. Child care facilities (pioneer the camp, etc.) shall not be placed in the centers of accumulation of snakes. Herpetologists can carry out resettlement of snakes from such places to reserves or zmeepitomnik.

Use of snake poison in medicine

3. I. use in medicine:

1) for preparation of anatoxins and immunization of animals for the purpose of receiving antitoxic serums;

2) as independent to lay down. drugs;

3) as reactants for laboratory diagnosis of some diseases;

4) for experimental modeling of a row patol, syndromes (neurotoxic, hemorrhagic, the disseminated blood coagulation and an afibrinogenemiya etc.).

To apply 3. I. how to lay down. means was begun in 16 century; as therapeutic means it was propagandized by Paracelsus. Broad practical application 3. I. began in 20 century.

Poison of rattlesnakes was applied to treatment of epilepsy (with problematic effect). Poison of a cobra and its neurotoxic fraction possess the expressed anesthetic, anti-spastic and anticonvulsant action; the cytolysins which are contained in it have resorptional effect on granulations and on cells of some tumors. It was shown that the weakened neurotoxin of poison of a cobra weakens action of a virus of poliomyelitis and probably other neuriviruses.

A number of drugs from poisons of the vipers possessing thromboplastic action is applied as local styptic means. To prevention and therapy of thromboses apply a defibrinating component of poison of the Malayan shchitomordnik — arvin or ankrod (Arvin, Ancrod). It is the glycoprotein which is chipping off peptides A from fibrinogen (but not In) and the fibrin-monomers causing incomplete polymerization without simultaneous activation of a fibrinstabiliziruyushchy factor. These friable fibrinmonomerny complexes quickly are exposed to a fibrinolysis with formation of a large number of the proteinaceous splinters possessing the expressed anticoagulating action. After single intravenous administration of an ankrod there comes the sharp hypocoagulation remaining apprx. 24 hours, viscosity of blood decreases.

Remains not studied an opportunity to lay down. uses of the anticoagulants which are contained in poisons of adders and some other snakes.

Poisons of snakes widely use in laboratory diagnostic practice, hl. obr. for recognition of various disturbances of coagulability of blood. So, tests with poison of a viper of Russell (stipveny) or gyurza (lebetoksy) use for differential diagnosis of deficit of factors of VII and X (poisons contain an analog of a factor of VII), and also for quantitative definition of a factor of X and a factor of 3 thrombocytes. The prothrombin is defined by poison of the Australian snake taypan or a sandy efa. Reptilaza (drug from poison of the Brazilian rattlesnakes) is applied to control of coagulability of blood and content of fibrinogen in it against the background of a geparinization (its action, unlike thrombin, is not blocked by heparin), and together with the thrombin test — to differentiation of various antithrombins etc.

3. I. is a source of receiving a number of the enzymes used for studying of structure and function biol, systems for receiving biologically active agents (bradikinin, etc.) and other purposes.

Drugs of snake poison

Vipraxinum (Vipraxinum) — aqueous solution of dry poison of a viper ordinary. Appoint as anesthetic and anti-inflammatory drug at neuralgia, mialgiya, polyarthritises, miozita. Use also for treatment ginekol, inflammatory diseases together with antibiotics.

Mechanism of action of Vipraxinum, as well as other drugs 3. I., it is not studied. Assume that along with specific action of the main components of poison to lay down. the effect is connected with reflex reactions (irritation of receptors), with absorption of the biogenic amines which are formed in fabrics at local action of poison with influence on immune responses of an organism, and also with stimulation of system a hypophysis — adrenal glands.

Administer the drug vnutrikozhno, subcutaneously or intramusculary to the area of the greatest morbidity. Begin treatment with an injection of 0,2 ml. Usually on site injections there is a puffiness, considerable pain is felt; also the fever, fervescence, a headache, nausea, vomiting are possible. In 3 — 4 days when the general and local reaction disappears, repeatedly enter the same dose (if local reaction was expressed) or increase it to 0,3 ml. In the absence of side effects 10 injections with an interval of 3 — 4 days in the same dose are appointed to a course of treatment, and at good tolerance of drug the dose can be increased to 0,4 ml and the interval between injections is reduced to 1 days. The maximum single dose — 1 ml. It is necessary to inject no more than 0,4 ml into one place, at a bigger single dose the drug is administered to 2 — 3 places. That drug did not lose activity, use the cooled syringe, free from alcohol.

Usually Vipraxinum is well transferred, however, as well as to other drugs 3. I., individually increased reaction is possible.

Vipraxinum at active tuberculosis is contraindicated, at insufficiency of coronary and cerebral circulation, defeats of parenchymatous bodies and at feverish states.

Form of release — an ampoule on 1 ml. Store in the soldered ampoules in the cool dark place; list A.

Viperalginum (Viperalgin) — The lyophilized sterile poison of a sandy viper containing a neurotoxin, hyaluronidase. On action, indications and contraindications it is close to Vipraxinum. Enter vnutrikozhno, subcutaneously or intramusculary, since a dose of 0,1 ml, with gradual increase it (on 0,1 ml every time) before emergence of noticeable local reaction. Make several injections with an interval not less than 1 days. By the end of treatment of a dose of drug gradually reduce.

A form of release — the ampoules containing 0,1 mg of dry poison, ampoules with solvent (1 ml of isotonic solution of sodium chloride) dissolve drug just before the use. Store as drug of the list A. It is made in ChSSR.

Viprosal (Viprosalum) — ointment, toxiferous gyurza (16 mouse PIECES on 100 g of ointment), with addition of camphor, salicylic to - you, fir oil, vaseline, glycerin, paraffin, emulsifier and water. The creamy mass of white or slightly yellow color, with a smell of camphor and fir oil.

Apply outwardly at neuralgia, a lumbago, miozita, arthralgias as anesthetic. Apply on healthy places 5 — 10 g of 1 — 2 time a day and rub dry. At use the local allergic reactions disappearing after drug withdrawal are possible.

A form of release — a tuba on 20, 30, 40 and 50 g. Store in the dry cool place.

Viprosal may contain instead of poison of a gyurza the amount of poison of a viper corresponding on activity ordinary.

Vipratoxum (Vipratox) — linimentum containing poisons of different snakes (0,0001 g), methyl salicylate (6 g), camphor (3 g) and a basis for linimentum (to 100 g). Apply outwardly.

Indications and a route of administration same, as for viprosal. A form of release — a tuba on 45 g. It is manufactured in GDR.

Bibliography: Barkagan 3. Page and Perfilyev P. P. Venomous snakes and their poisons, Barnaul, 1967, bibliogr.; B of e r d y e-in and A. T. K to a pathogeny of intoxication poisons of the Central Asian snakes of a gyurza and a cobra, Ashgabat, 1972, bibliogr.; it, Snake poisons, their toxic action and measures of assistance at stings of snakes, Ashgabat, 1974, bibliogr.; Valtseva I. A. Pathophysiological features of effect of poisons of the snakes living in the territory of the USSR and some questions of experimental therapy, M., 1969; Mashkovsky M. D. Pharmaceuticals, p. 2, page 108, M., 1977; With and x and about in D. N., Sorokinv.M.iyukelsonl. Ya. Himiya and biochemistry of snake poisons, Tashkent, 1972, bibliogr.; Poisonous animals of Central Asia and their poisons, under the editorship of G. S. Sultanov, Tashkent, 1970; Venomous animals and their venoms, ed. by W. Biicherl a. E. F. Buckley, N. Y. — L., 1971.

3. S. Barkagan; V. A. Babichev (pharm.).