Characteristics of Echis carinatus viper snake bite (a) tense bleb at the site of bite, (b) active gum bleed, (c) active epistaxis.

Viper venom interferes with blood clotting. Venoms contain serine proteases, metalloproteinases, C-type lectins, disintegrins, and phospholipases, and it exhibits both anticoagulant and procoagulant effects on blood clotting mechanism resulting in defibrination syndrome or disseminated intravascular fibrino-coagulopathy.

Haemorrhagins-1, 2 and metallo-endopeptidase causes acute rapid bleeding in brain, lungs, kidney, heart, and gastrointestinal tract. It causes severe vasoconstriction followed by vasodilatation of the microvessels. Endothelial gaps due to disintegration of the endothelial cells within intracellular edema, swollen mitochondria, dilated endoplasmic reticulum, and separation of intracellular junction of the endothelial cells. Local loss of basement membrane of the vessels leads to capillary leaking syndrome and a resistant shock

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