Russell's viper coiled around adrenal glands symbolizing Addisonian crisis.

When a Snakebite Turns Deadly: Understanding Addisonian Crisis

Rhea Morgan in Health & Wellness August 2025 • 3 min read.

"A rare complication of Russell's viper venom can lead to adrenal failure. Learn to recognize the signs and seek immediate treatment."

Snakebite envenomation is a significant public health concern in tropical countries, particularly in rural areas. The Russell's viper (Daboia russelii), a venomous snake belonging to the Viperidae family, is responsible for a notable proportion of snakebite incidents in the Indian subcontinent.

While many know the immediate dangers of snake venom, a less common but equally devastating complication is Addisonian crisis. This occurs when the adrenal glands, responsible for producing essential hormones, fail due to the venom's effects.

This article delves into a specific case of Russell's viper envenomation leading to Addisonian crisis, highlighting the importance of early recognition, supportive care, corticosteroid therapy, and timely antivenom administration for a positive outcome.

What is Addisonian Crisis and How Does a Snakebite Trigger It?

Russell's viper coiled around adrenal glands symbolizing Addisonian crisis.

Addisonian crisis, or acute adrenal insufficiency, is a life-threatening condition where the adrenal glands don't produce enough cortisol and aldosterone. These hormones regulate vital functions like blood pressure, blood sugar, and the body's response to stress. Without sufficient hormone levels, the body can go into shock.

While Addisonian crisis can be caused by various factors, including autoimmune diseases and infections, this article focuses on a rare trigger: Russell's viper venom. The venom's vasculotoxic effects can lead to adrenal hemorrhage, damaging the adrenal glands and impairing hormone production.

Vasculotoxicity: Russell's viper venom damages blood vessels.
Adrenal Hemorrhage: Damaged vessels lead to bleeding in the adrenal glands.
Hormone Deficiency: Bleeding disrupts hormone production, causing crisis.

In the case presented, a 28-year-old shepherd, bitten by a Russell's viper, initially responded well to antivenom. However, days later, he developed severe abdominal pain, vomiting, fever, and dangerously low blood pressure. Doctors diagnosed Addisonian crisis caused by adrenal hemorrhage. Early intervention with hydrocortisone dramatically improved his condition.

Key Takeaways: Recognizing and Responding to the Threat

This case underscores the importance of recognizing the potential for Addisonian crisis following Russell's viper envenomation. Even if initial treatment seems successful, delayed complications can arise.

Be alert for symptoms like sudden abdominal pain, vomiting, fever, low blood pressure, and altered mental status. Immediate medical attention, including corticosteroid therapy, is crucial.

While rare, Addisonian crisis is a life-threatening complication of Russell's viper bites. Increased awareness and prompt treatment can significantly improve patient outcomes in affected regions.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1016/j.wem.2018.06.001, Alternate LINK

Title: Russell'S Viper Envenomation-Associated Addisonian Crisis

Subject: Public Health, Environmental and Occupational Health

Journal: Wilderness & Environmental Medicine

Publisher: Elsevier BV

Authors: Subramanian Senthilkumaran, Ritesh G. Menezes, Syed Ather Hussain, Sushil Allen Luis, Ponniah Thirumalaikolundusubramanian

Published: 2018-12-01

Everything You Need To Know

What is Addisonian crisis, and how does a snakebite cause it?

Addisonian crisis is a serious condition resulting from insufficient production of cortisol and aldosterone by the adrenal glands. These hormones are essential for regulating crucial bodily functions such as blood pressure, blood sugar, and the body's stress response. The Russell's viper venom can trigger this crisis by causing vasculotoxic effects, leading to adrenal hemorrhage, which damages the adrenal glands and impairs hormone production. Without the essential hormones, the body can enter a state of shock, posing a severe threat to life.

Why is the Russell's viper so dangerous in relation to this medical condition?

The Russell's viper is a venomous snake found in the Indian subcontinent. Its venom is particularly dangerous because of its vasculotoxic effects, meaning it damages blood vessels. This damage can lead to various complications, including adrenal hemorrhage, which then can cause Addisonian crisis. This is why understanding the potential for this complication is crucial in regions where this viper is prevalent.

How does the vasculotoxicity of the Russell's viper lead to Addisonian crisis?

Vasculotoxicity, the damaging effect of Russell's viper venom on blood vessels, plays a critical role. This venom's impact can lead to adrenal hemorrhage. This causes bleeding within the adrenal glands, ultimately disrupting their hormone production, specifically cortisol and aldosterone, which leads to Addisonian crisis. The implications are severe, potentially leading to shock, organ failure, and even death if not promptly addressed with appropriate medical intervention.

What are the signs and symptoms of Addisonian crisis following a snakebite?

The symptoms of Addisonian crisis can include severe abdominal pain, vomiting, fever, and dangerously low blood pressure. These symptoms arise from the hormonal imbalances caused by adrenal gland failure. A person bitten by a Russell's viper, even if initially responding well to antivenom, can develop these symptoms days later. Prompt recognition of these signs and immediate medical attention, including supportive care, corticosteroid therapy, and potentially additional antivenom, are crucial for a positive outcome.

Why is early recognition of Addisonian crisis so important after a snakebite from a Russell's viper?

Early recognition is vital because Addisonian crisis can be a delayed complication of a Russell's viper bite, even after successful initial antivenom treatment. Prompt treatment with supportive care and corticosteroid therapy, like hydrocortisone, can dramatically improve a patient's condition. The timely administration of antivenom is crucial initially, but recognizing and treating Addisonian crisis are essential steps to save lives when dealing with Russell's viper envenomation.