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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
 
 
 
 
 
 
 
 

Emergency & clinical flowcharts

 

Signs and symptoms1
  Emergency medical treatment
  Identification of the cause
  Antivenom2
     
   Possible cause
   
      
Nausea, vomiting, abdominal pain, diarrhoea, urticaria, angio-oedema, bronchospasm, arterial hypotension (autopharmacological effects of the venom including anaphylaxis)   Treatment of anaphylactic/ anaphylactoid reactions  

1. Morphological identification (Fig. 4.49 for differentiation from terrestrial snakes and fish)

 

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

 

 

MAVIN Antivenom index

 

See Antivenom indications

 

Antivenom efficacy

 

 

 
  
    
Generalised oedema → hypovolaemia → hypovolaemic shock (autopharmacological effect of the venom: increased capillary permeability)   Treatment of the hypovolaemia/hypovolaemic shock  
 
  
    
Pulmonary oedema,
cerebral oedema
(autopharmacological effect of the venom: increased capillary permeability)
  Treatment of the non-cardiogenic pulmonary oedema, treatment of the cerebral oedema  
 
  
    
Extensive local swelling possibly involving the trunk → hypovolaemia → hypovolaemic shock (local effect of the venom: regionally increased capillary permeability)  

Treatment of the hypovolaemia/hypovolaemic shock

 
 
  
    
Systemic bleeding → hypovolaemia → haemorrhagic shock (haemostatic effects of the venom)   Treatment of the haemorrhage-induced hypovolaemia/ haemorrhagic shock  
 

    
Intracranial bleeding → focal neurological deficits, coma, meningismus (haemostatic effects of the venom)   Treatment of intracranial bleeding  
 
  
    
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:
 
 
  Astrotia stokesii   
    
Myalgia, painful musculature with active and passive movement and upon pressure, urine colour, ECG changes, signs of paralysis,  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
 
 
 

Astrotia stokesii

Enhydrina schistosa

Hydrophis sp.

 
    
Myocardial symptoms, cardiac dysrhythmias, ischaemia (ECG), cardiac insufficiency, heart failure
(usually secondary, rarely primary cardiac effects of the venom)
  Treatment of the cardiac disturbance  
 
   
    
Acute renal failure
(usually secondary, rarely primary renal effects of the venom)
  Treatment of the acute renal failure  
 
   
       
No or insufficient clinical data      
 
 

Genera3

Acalyptophis
Aipisurus
Disteira
Emydocephalus
Ephalophis
Hydrelaps
Kerilia
Kolpophis
Lapemis
Laticauda

Parahydrophis

Pelamis
Praescutata
Thalassophis

 

 

1
See also the Clinical flowchart as a guide to the dynamics of envenoming.
2 See "Essentials of the management of envenoming and poisoning: 9. How is the appropriate antivenom chosen? When is it administered?"
3 These cases are also dealt with in accordance with the corresponding problem-oriented section "Diagnosis & Treatment".