Clinical Flowchart

Autopharmacological effects

Crotalus sp. Bothrops asper
Minutes (to hours)

Nausea, vomiting, abdominal pain, diarrhoea (urticaria, angio-oedema) (bronchospasm) arterial hypotension		Crotalus sp.
		Hours

		Generalised oedema

		Hypovolaemia/hypovolaemic shock

Cardiovascular failure

Local effects

Bothrops asper Crotalus sp. Lachesis sp.
Minutes (to hours)

Local pain and swelling

Painful swelling of the regional lymph nodes

Bothrops asper		Bothrops asper Crotalus sp. Lachesis muta
Days		Hours

		Extensive swelling

		Hypovolaemia

Necrosis Loss of function of extremities Loss of extremities

Haematological effects

Bothrops asper (Crotalus sp.) Lachesis sp.
< 1 hour to hours

Gingival bleeding

Bleeding from wounds remote from the site of the bite

Haematemesis, bleeding per rectum, haematuria

Systemic bleeding		Intracranial bleeding (focal neurological deficits, meningismus, coma)

Hypovolaemia/haemorrhagic shock

Cardiovascular failure	Renal failure	CNS failure

Neurological effects

Micrurus sp.
Crotalus scutulatus (Mexico)?

Minutes to hours

Cranial nerve deficits (ptosis, ophthalmoplegia, dysphagia, dysarthria)

Paralysis of the skeletal musculature including the respiratory musculature

Respiratory failure

Lachesis sp.

"Bushmaster (Lachesis spp.) envenoming causes a distinctive autonomic syndrome of sweating, repeated bilious vomiting, severe abdominal colic, profuse diarrhoea, hypotension, sinus bradycardia, and shock that can develop as early as 15 min after the bite.” (Warrell and Williams 2023).

Muscular effects

Cardiac effects

Renal effects

?¹

1	Bothrops sp.:AKI results from a combination of factors, possibly including direct action of the venom (Malaque and Gutiérrez 2017; Pinho et al. 2008, Sitprija 2006; Warrell 2004, 2023).