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V1.6.11 T354
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Poisonous animals
Cnidarians (Jellyfish, Corals and Anemones)
Venomous fish
Hymenopterans (Bees, Wasps and Ants)
Sea snakes
Terrestrial snakes
Miscellaneous animals

Is the patient envenomed?


Is it likely that a clinically relevant injection of venom has taken place?

D  Diagnostics

Inquire re:

  • time of the bite,
  • local pain,
  • nausea, vomiting.


  • state of consciousness (restlessness, sleepiness, coma).


  • blood pressure/pulse,
  • breathing (respiratory rate).


  • local swelling,
  • local redness.

Systemic reactions:

  • sweating,
  • hypersalivation, increased bronchial secretion,
  • priapism,
  • abdominal pain (acute pancreatitis),
  • bradycardia/tachycardia/cardiac arrhythmia,
  • arterial hypotension/hypertension,
  • apical systolic murmur (mitral regurgitation), protodiastolic gallop,
  • clinical signs of pulmonary oedema,
  • clinical signs of shock,
  • clinical signs of acute hypertensive encephalopathy,
  • blurred vision, "wandering" eye movements,
  • dysphagia,
  • dysarthria,
  • pharyngeal reflex,
  • generalised muscle pain and cramps,
  • muscle weakness,
  • paralysis of the respiratory musculature (respiratory failure).

Record and measure:

  • ECG (cardiac arrhythmias, "myocardial infarction-like pattern"),
  • blood sugar.

Exclusion of a clinically relevant systemic reaction

D  Diagnostics

Monitoring for signs and symptoms of systemic envenoming for 12–24 h.

C  Comments

Severe systemic symptoms of envenoming may first arise a long time after the sting (see Parabuthus spp.; Müller 1993, Smith et al. 1983).