Emergency Flowchart

Signs and symptoms^1,2	Emergency medical treatment	Identification of the culprit	Antivenom

	Possible cause


Cranial nerve deficits, paralysis of the skeletal musculature including the respiratory musculature (neurological effects of the venom) → respiratory insufficiency, respiratory failure	Treatment of the respiratory insufficiency/respiratory failure: endotracheal intubation and artificial respiration	Narrowing down the cause with the aid of indirect criteria Distribution Syndromic approach: Combination of signs & symptoms of first column of this flowchart and Clinical flowchart as a guide to the dynamics of envenoming. Follow also links to species- and family-specific 'Clinical entries: Sea snakes'.	WHO Snakebite Information and Data Platform Antivenom indications

	Hydrophis stokesii (= Astrotia stokesii) Laticauda colubrina

Myalgia, pain on active/passive movement, upon pressure (muscular effect of the venom: rhabdomyolysis) Hyperkalaemia, hypercalcaemia (ECG changes) Urin colour (myoglobinaemia), flank pain on percussion (renal failure secondary to rhabomyolysis) Signs of paralysis, including respiratory muscles (respiratory failure)	Treatment of the hyperkalaemia and hypercalcaemia, prevention / treatment of the acute renal failure, treatment of the respiratory insufficiency/respiratory failure

	Hydrophis stokesii (= Astrotia stokesii) Hydrophis schistosus (=Enhydrina schistosa) Hydrophis sp.

No/insufficient data, no clinically relevant cases of envenoming known	Follow ABCDE approach	As above, with limitations	Check for updates in case of an accident

	Genera³ Acalyptophis Aipisurus Disteira Emydocephalus Ephalophis Hydrelaps Kerilia Kolpophis Lapemis Parahydrophis Pelamis Praescutata Thalassophis

1	See also Clinical flowchart as a guide to the dynamics of envenoming.
2	Local effects are uncommon in sea snakebite and are minimal.