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  5. Clinical entry: Micropechis ikaheca

Clinic: Micropechis ikaheca

Examine for venom effects

Autopharmacological effects

  • Nausea, vomiting
  • Sweating
  • Urticaria, angiooedema
  • Arterial hypotension / hypovolaemic shock (transient, recurrent; immediate; delayed (CLS))
  • Diarrhoea
  • Bronchospasm 

Local Effects

  • Pain
  • Tender local (spreading) swelling
  • Blistering
  • Lymphangiopathy and lymphadenopathy
  • Necrotic skin

Haematological effects 

  • Clotting disturbances:
    • Bleeding from the fang marks and from injuries, in particular ones that are not located in the region in which venom application occurred.
    • Bleeding into the skin (ecchymosis, petechiae)
    • Gingival bleeding, bleeding from the nose, conjunctiva, haematemeis, bleeding per rectum, including melaena, haematuria, haemoptysis.
    • Oliguria, anuria (VICC / AKI)
  • Bleeding and/or haemolytic anaemia:
    • Arterial hypotension (haemorrhagic shock)
    • Acute abdomen (intra-abdominal bleeding!)
    • Loin pain/renal bed sensitive to percussion (ischaemia, renal haemorrhage!)
    • Local neurological signs, meningism, coma (intracranial bleeding!)
    • Pale sclera
    • Oliguria, anuria (arterial hypotension / AKI)

Neurological effects

  • Descending flaccid paralysis (rarely progresses to involve bulbar and respiratory muscles):
    • Ptosis (not to be mixed up with tiredness / drowsiness; test: lid retraction with upward gaze).
    • Double vision (external ophthalmoplegia)
    • Difficulties to swallow (dysphagia) (bulbar paralysis) > inhalation of vomitus!
    • Difficulties to lift the head when lying on the back (‘broken neck syndrome’)
    • Cyanosis, shallow breathing, respiratory arrest (respiratory paralysis); respiratory arrest may be precipitated by obstruction of the upper airway by the paralysed tongue or inhaled vomitus. 
    • Weakness or loss of voluntary movement; movements of digits may still be possible, allowing the patient to communicate.
    • Loss of consciousness and generalized convulsions caused by hypoxaemia in patients who have respiratory paralysis.  

Muscular effects

  • Generalized rhabdomyolysis:
    • Muscles pain and tenderness, painful on passive stretching, muscle stiffness, trismus
    • Bulbar and respiratory muscle weakness.
    • Dark brown urine. 
    • Renal failure
    • Laboratory: Generalized rhabdomyolysis: defined by a serum creatine kinase level > 10,000 U/l
    • ECG: Signs of hyperkalaemia. 

Species-specific envenoming pattern

The assessment of the envenoming pattern is based on the data from publication in which the identification of the snakes is clearly specified and in accordance with accepted criteria.

   Autopharma-
cological
effects1 		 Local
effects2
 		 Haematological effects Neurological
effects5		 Musular
effects6
 Bleeding3  Coagulopathy4

Micropechis ikaheca

          

1Autopharmacological effects

  • Vomiting and dizziness within 1h of the bite (Warrell et al. 1996).
  • Vomiting (Blasco and Hornabrook 1972).

2Local effects

Local pain and swelling at the site of the bite, lymphadenopathy (Warrell et al. 1996).

Haematological effects

3Bleeding 
Micropechis ikaheca
Spontaeous bleeding (Warrell et al. 1996).

4Coagulopathy
Incoagulable blood (Warrell et al. 1996).

Type of haemostatic defect 
Micropechis ikaheca

5Neurological effects

Ptosis, bulbar paralysis, limb paralysis) (Warrell et al. 1996).
Paralysis of the extremities and respiratory musculature resulting in death (Blasco and Hornabrook 1972).

6Muscular effects

Generalized muscle pain / tenderness, trismus, dark urine (Warrell et al. 1996).

Other effects

Cardiovascular effects? (Tibbals et al. 2003).

Case fatality rate

2/11 (19 and 38h after the bite; respiratory paralysis) (Warrell et al. 1996).

Clinical management

See also Clinical Management: australia and the pacific islands

First Aid

If a tourniquet has been applied, it should not be removed until

  • systemic envenoming has been excluded: absence of non-specific systemic symptoms and normal results of laboratory investigations (Ireland et al. 2010, Isbister and Berling 2025)
    or
  • after compeltion of antivenom administration for patients with systemic envenoming (Isbister et al. 2025).
  • adverse outcomes have been observed in patinets with tight pressure bandages left in place for many hours (Little 2023).
  • all patients must be observed after removal of the bandage.

Local treatment

Pain control
Tetanus prophylaxis
Standard wound care
WHO (2010) 

Systemic supportive treatment

A general understanding of emergency medicine is required, or can be found in emergency medicine guidelines, e.g. ABCDE approach, WHO-ICRC Basic Emergency Care.

Follow SAMPLE & ABCDE ApproAch

Obey Micropechis ikaheca - specific features

see 

  • 'Species-specific envenoming pattern' above

and

Key issues

See footnotes above

Specific treatment (antivenoms)

References

see also references in section 'species specific evidence' (below). 

  • Tibballs J, Kuruppu S, Hodgson WC, Carroll T, Hawdon G, Sourial M, Baker T, Winkel K. Cardiovascular, haematological and neurological effects of the venom of the Papua New Guinean small-eyed snake (Micropechis ikaheka) and their neutralisation with CSL polyvalent and black snake antivenoms. Toxicon. 2003 Nov;42(6):647-55. PMID: 14602120. https://doi.org/10.1016/j.toxicon.2003.09.002
  • WHO-ICRC Basic Emergency Care: approach tothe acutely ill and injured (2018)
    https://www.who.int/publications-detail-redirect/basic-emergency-care-approach-to-the-acutely-ill-and-injured
  • WHO ABCDE Approach
    https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/bec-quick-cards/becp-edu29-pdf-en-finl.pdf?sfvrsn=2532d61b_2
  • WHO (2010) Guidelines for the prevention and clinical management of snakebite in Africa. https://www.who.int/publications/i/item/9789290231684
  • WHO Snakebite Information and Data Platform
    https://www.who.int/teams/control-of-neglected-tropical-diseases/snakebite-envenoming/snakebite-information-and-data-platform
  • Warrell DA. Venomous and poisonous animals. In: Farrar J, Garcia PJ, Hotez T, Junghanss T, Kang G, Laloo D (eds.). Manson’s tropical diseases. 24th ed. Elsevier; 2023.
  •  Warrell DA, Williams DJ. Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet. 2023 Apr 22;401(10385):1382-1398. PMID: 36931290. https://doi.org/10.1016/s0140-6736(23)00002-8 

Species-specific evidence

Micropechis ikaheca

Papua New Guinea

  • Warrell et al. (1996) 
    11 patients; identification: immunological, morphological (1/11). Systemic envenoming 6/11, no clinical evidence of envenoming 5/11.
  • Blasco and Hornabrook (1972)
    1 case; very doubtful identification; discussion of several cases with a similar course.

References

  • Blasco, P., R. W. Hornabrook (1972) A neglected but potentially dangerous New Guinea snake-the small eyed snake (Micropechis ikaheka). Papua N. Guinea med. J. 15: 155-156
  • Warrell, D. A., B. J. Hudson, D. G. Lalloo, A. J. Trevett, et al. (1996) The emerging syndrome of envenoming by the New Guinea small-eyed snake Micropechis ikaheka. Q. J. Med. 89: 523-530