How fo Recognize Snake Venom Poisoning 



the tongue and moutli or scalp. Paresthesia 

 about the wound is sometimes reported. 



Viperid venom poisoning is cliaracterized by 

 burning pain of rapid onset, swelling and edema, 

 and patchy skin discoloration and ecchymosis in 

 the area of the bite. Extravasation of blood 

 from the wound site is common in Russell's and 

 saw-scaled viper envenomations. The failure of 

 the blood to clot is a valual)le diagnostic finding. 

 Bleeding from the gums, and the intestinal and 

 urinary ti-acts is conmion in severe Russell's and 

 saw-scaled viper bites. 



Cobra envenomation is characterized by ])ain 

 usually within 10 minutes of the bite, and this is 

 followed by localized swelling of slow onset, 

 drowsiness, weakness, excessive salivation, and 

 paresis of the facial muscles, lips, tongue, and 

 larynx. The pulse is often weak, blood pressure 

 is reduced, respirations are labored, and there 

 may be generalized muscidar weakness or paraly- 

 sis. Ptosis, blurring of vision, and headache may 

 be present. Contrary to popular opinion, ne- 

 crosis is not an uncommon consecpience of cobra 

 venom poisoning. In bites by the kraits a simi- 

 lar clinical picture is usually seen, except that 

 there is very little or no local swelling or severe 

 pain. The systemic manifestations may often be 

 more severe, and shock, marked respiratory de- 

 pression and coma, may rapidly develop. Ab- 

 dominal pain is often intense following jioison- 

 ing by the kraits, mambas, and faipans. Enven- 

 omation by coral snakes may resemble krait 

 venom ]ioisoning. The bite is usually less ])ain- 

 ful, and there is occasionally a sensation of 

 numbness about the w()un<l. Clicsl pain. ]iarli- 

 cularly on inspii-alion, is sometiiucs rcjjorted. 

 Localized edema is minimal and necrosis is I'are. 



Mamba venom poisoning is characterized by 

 weakness, nausea and vomiting, blurred vision, 

 slurred speech, excessive salivation, headache, and 

 abdominal jiain. These findings are often fol- 

 lowed by hy|)otension, respiratory distress, and 

 shock. 



Envenomation by most of the Australian- 

 Papuan elapids produces drowsiness, visual dis- 

 turbances, ptosis, nausea and vomiting, headache, 

 abdominal pain, slurring of speech, respiratory 

 distress, and genei'alized muscular weakness or 

 paralysis. Hemoglobinuria may be found early in 

 the course of the poisoning. 



Sea snake venom poisoning is iisually charac- 

 terized by multiple pinhead-sized puncture 

 wounds, little or no localized pain, oftentimes 

 tenderness and some jiain in the skeletal muscles 

 and, in particular, the larger muscle masses and 

 the neck. This pain is increased xyith motion. 

 The tongue feels thick and its motion may be re- 

 stricted. There may be jiaresthesia about the 

 mouth. Sweating and thirst are conunon com- 

 plaints, and the ])atient may complain of pain 

 on swallowing. Trismus, extraocular weakness 

 or i^aralysis, dilatation of the jnipils, ptosis and 

 generalized weakness may be present. Respiratory 

 distress is common in severe cases. Myoglobi- 

 nuria is diagnostic. 



r^ittlc is known about the problem of enveno- 

 mation by rear-fanged colubrid snakes. The 

 .\frican l>oomslang and bird snake are known 

 to produce se^"ere jioisoning, which on rare oc- 

 casions may be fatal. (These snakes are desciibed 

 on ])p. 00-01.) Other species of colubrids, some 

 with enlarged grooved fangs and some with solid 

 teeth, are known to bite and may be venomous. 

 The manifestations of jwisoning by known ven- 

 omous colubrids, such as the mangrove snake 

 (lioif/fi (lentlrophihi) of southeast Asia, (he AVest 

 Indian racers (AJso/>h!x), the "culebra de cola 

 coi'ta" ( Ti/rht/mrnx/'x pcnirunui) nl' western 

 Souili .Vnicrica, the ])arrot snakes (Leptophist) of 

 tropical America and several other sjiecies are 

 local pain and swelling, sometimes accompanied 

 liy localized skin discoloration and ecchymosis; 

 and in the more severe en\enoiHal ions, increased 

 swelling and edema \\hi<-h may involve the entire 

 injured extremity, general malaise and f<>\er. 

 Tlie acute ])eriod of the poisoning may persist 

 for 4 to 7 days. It is im])ortant to d i tie rent iate 

 envenomation by colubrids from that by the more 

 dangerous ela])ids and vipers. 



In smnmary, any snakebite associated with im- 

 mediate (and sometimes intense) pain, and fol- 

 lowed within several mimites by the appearance 

 of swelling and subsequently edema is usuallj' 

 diagnostic of snake venom poisoning by a viper. 

 Elapid envenomation, on the other hand, is not so 

 easily diagnosed during the first 10 minutes fol- 

 lowing the bite. Pain, usually of minor intensity, 

 maj' appear within the first 10 minutes, although 

 in .some cases it is not reported for .')0 minutes or 

 even longer. Swelling usually appears 2 or 3 



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