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Poisonous animals
 
Cnidarians (Jellyfish, Corals and Anemones)
 
Venomous fish
 
Scorpions
 
Spiders
 
Hymenopterans (Bees, Wasps and Ants)
 
Sea snakes
 
Terrestrial snakes
 
Miscellaneous animals
 
North America
 
Mexico and Central America
 
South America and the West Indies
 
Europe
 
North Africa, Near and Middle East
 
Central and Southern Africa
 
The Far East
 
Indian Subcontinent and Southeast Asia
 
Australia and the Pacific Islands
 
 
 
 
 
 
 
 

Emergency & clinical flowcharts

 

Signs and symptoms1   Emergency medical treatment     Identification of the cause3   Antivenom4
     
   Possible cause2     
      
Nausea, vomiting, abdominal pain, diarrhoea, urticaria, angio-oedema, bronchospasm, arterial hypotension (autopharmacological effects of the venom including anaphylaxis)   Treatment of anaphylactic/anaphylactoid reactions   Identification strategies:

1. Morphological identification key (if snake is available for identification)

2. Narrowing down the cause with the aid of indirect criteria:

 

WHO Antivenom list

 

See Antivenom indications

 

Antivenom efficacy8

 
  Echis sp.
Daboia russelii
 
    
Generalised oedema → hypovolaemia → hypovolaemic shock (autopharmacological effects of the venom: increased capillary permeability)   Treatment of the hypovolaemia/hypovolaemic shock  
 
  Daboia russelii siamensis  
    

Pulmonary oedema,

cerebral oedema

(autopharmacological effects of the venom: increased capillary permeability)

 

Treatment of the non-cardiogenic pulmonary oedema, treatment of the cerebral oedema

 
 
  Daboia russelii siamensis  
    
Extensive local swelling possibly involving the trunk → hypovolaemia → hypovolaemic shock (local effects of the venom: regionally increased capillary permeability)  

Treatment of the hypovolaemia/hypovolaemic shock

 
 
 

Calloselasma rhodostoma

Trimeresurus sp. (according to the former classification)
Hypnale sp.

 
    
Systemic bleeding → hypovolaemia → haemorrhagic shock (haemostatic effects of the venom)   Treatment of the haemorrhage-induced hypovolaemia/haemorrhagic shock  
 
  Daboia russelii
Calloselasma rhodostoma
Trimeresurus sp. (according to the former classification)
Hypnale sp.
 
    
Intracranial bleeding → focal neurological deficits, coma, meningismus (haemostatic effects of the venom)
 
  Treatment of intracranial bleeding  
 
 

Echis sp.

Daboia russelii5
Calloselasma rhodostoma
Trimeresurus sp. (according to the former taxonomic classification)

 
    
Cranial nerve deficits, paralysis of the skeletal musculature including the respiratory musculature → respiratory insufficiency, respiratory failure (neurological effects of the venom)
 
  Treatment of the respiratory insufficiency/respiratory failure: acetylcholinesterase inhibitors, endotracheal intubation and artificial respiration  
 
 

Bungarus sp
Naja sp.6,7
Ophiophagus hannah
Daboia russelli pulchella 

 
    
Myalgia: spontaneous, with active/passive movement, upon pressure, ECG changes (hyperkalaemia), signs of paralysis, urine colour (differential diagnosis haemoglobinuria), renal failure (muscular effect of the venom: rhabdomyolysis)   Treatment of the hyperkalaemia,
prevention and treatment of the acute renal failure,
treatment of
the respiratory insufficiency/ respiratory failure
  • endotracheal intubation and artificial respiration
 
 
 

D. russelii pulchella 

Bungarus niger (and possibly other kraits)

 
    
Myocardial symptoms, cardiac dysrhythmias, ischaemia (ECG), cardiac insufficiency, heart failure (usually secondary, rarely primary cardiac effects of the venom)   Treatment of the cardiac disturbance  
 
  (Naja sp.)
(
Calloselasma rhodostoma)
 
    
Acute renal failure (usually secondary, rarely primary renal effects of the venom)   Treatment of the acute renal failure  
 
  Daboia russelii
Hypnale sp.
 
       
No/insufficient data, no clinically relevant cases of envenoming known    
 
 

Colubridae

Calliophis sp.9

Hemibungarus calligaster9

Sinomicrurus sp.

Azemiops feae9
Eristicophis macmahoni9
Pseudocerastes persicus9
Macrovipera lebetina9
Gloydius himalayanus9
Deinagkistrodon acutus9

 

 

1 See also the Clinical flowchart as a guide to the dynamics of envenoming.
2 Taxonomic name without parentheses/(in parentheses)/((in double parentheses)): these signs and symptoms are regularly/(rarely)/((questionably)) observed following bites by these species.
3 Identification of the cause insofar as is necessary for differential treatment (see "Essentials of the management of envenoming and poisoning: 3. What level of identification of the animal that caused the accident is necessary?").
4 See "Essentials of the management of envenoming and poisoning: 9. How is the appropriate antivenom chosen? When is it administered?".
5 Acute pituitary insufficiency (in particular D. russelli siamensis).
6 Local symptoms of envenoming in the eyes (Spitting cobras: Naja mandalayensis, Naja philippinensis. Naja samarensis, Naja siamensis, Naja sputatrix, Naja sumatrana and to some extend also Naja kaouthia).
7 Neurological effects with signs of paralysis, including the respiratory musculature, of varying severity. Very significant and well documented with Naja naja and Naja philippinensis. With other Naja species the local effects often dominate (e.g. Naja kaouthia).
8 If clinical information regarding the efficacy of an antivenom is available, it is presented in the relevant Biomedical database entry.
9 These cases are also dealt with in accordance with the corresponding problem-oriented section "Diagnosis & Treatment".