Clinical Flowchart
Autopharmacological effects
|
Atractaspis sp.
|
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| Minutes (to hours) | ||||
| Nausea, vomiting, abdominal pain, diarrhoea
(urticaria, angio-oedema) (bronchospasm) arterial hypotension |
Bitis arietans
Daboia palaestinae |
|||
| Hours | ||||
|
Non-cardiogenic pulmonary oedema Cerebral oedema |
Generalised oedema | |||
| Hypovolaemia/hypovolaemic shock | ||||
| Cardiovascular failure | ||||
Local effects
|
Bitis arietans
|
||
| Minutes (to hours) | ||
| Local pain and swelling | ||
| Painful swelling of the regional lymph nodes | ||
|
Naja nigricollis1 Bitis arietans |
Bitis arietans Daboia palaestinae Naja nigricollis1 |
|
| Days | Hours | |
| Extensive swelling | ||
| Hypovolaemia | ||
| Necrosis
Loss of function of extremities Loss of extremities |
||
| 1 | Spitting cobras: Eyes! |
Haematological effects
|
Bitis arietans
|
||||
| < 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
|
||
| 1 | Additonally, thrombotic microangiopathy is observed in Echis sp. and Daboia palaestinae envenoming. |
Neurological effects
| Naja sp. (neurotoxic cobras)
(Walterinnesia sp.?) |
| Minutes to hours |
| Cranial nerve deficits (ptosis, ophthalmoplegia, dysphagia, dysarthria) |
| Paralysis of the skeletal musculature including the respiratory musculature |
| Respiratory failure |
Muscular effects
Not observed.
Cardiac effects
Bitis arietans: hypotension, bradycardia: among other factors direct myocardial effect of the venom? (Warrell et al. 1975).“Myocardial damage and cardiac arrhythmias may contribute to hypotension, a cause of early deaths.” (Amr et al. 2020).
Renal effects
|
Bitis arietans1 Cerastes cerastes1 |
| Hours to days |
| Flank pain, renal bed sensitive to percussion |
| Urinary output <400 ml/24 h |
| Renal failure |
| 1 | According to the available data, acute renal failure following a snakebite in North Africa and the Near and Middle East generally appears to be a secondary effect (arterial hypotension, shock, DIC).
For Bitis arietans and Cerastes cerastes venom a primary nephrogenic effect is discussed (Warrell et al. 1975, Schneemann et al. 2004). |