Go to start page
V1.2.0 (T12376)
Disclaimer & Information
Search
Show Mindmap
 
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
  In North America, with regard to antivenom treatment, only crotalids and elapids (M. fulvius) need to be distinguished as the cause

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 efficacy5

 

 
  Agkistrodon sp.
Crotalus sp.
Sistrurus sp.
 
    
Generalised oedema → hypovolaemia → hypovolaemic shock (autopharmacological effect of the venom: increased capillary permeability)
  Treatment of the hypovolaemia/hypovolaemic shock
 
 
  Crotalus sp.  
    

Pulmonary oedema,
cerebral oedema
(autopharmacological effect of the venom: increased capillary permeability)

 

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

 
 
  Crotalus sp.  
    
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

 
 
  Agkistrodon sp.
Crotalus sp.
Sistrurus sp.
 
    
Systemic bleeding → hypovolaemia → haemorrhagic shock (haemostatic effects of the venom)
  Treatment of the haemorrhage-induced hypovolaemia/haemorrhagic shock  
 

((Agkistrodon sp.))
(Crotalus sp.)
(Sistrurus sp.)

    
Intracranial bleeding → focal neurological deficits, coma, meningismus (haemostatic effects of the venom)
 
  Treatment of intracranial bleeding  
 
  ((Agkistrodon sp.))
(Crotalus sp.)
(Sistrurus sp.)
 
    
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
 
 
 

Micrurus sp.

Crotalus scutulatus

 
    
Myalgia: spontaneous, with active/passive movement and 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
 
 
  Crotalus horridus  
    
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/insufficient data, no clinically relevant cases of envenoming known      
 
 

Colubridae6

Micruroides eurxyanthus6

 

 

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 If clinical information regarding the efficacy of an antivenom is available, it is presented in the relevant Biomedical database entry.
6 These cases are also dealt with in accordance with the corresponding problem-oriented section "Diagnosis & Treatment".