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Snake Envenomation Overview: Differential Diagnoses & Workup

Author: Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Contributor Information and Disclosures

Updated: Aug 20, 2009

Differential Diagnoses

Anaphylaxis
Serum Sickness
Deep Venous Thrombosis
Wasp Stings
Extremity Vascular Trauma
Wound Care
Scorpion Sting
Wound Infection
Septic Shock

Other Problems to Be Considered

Nonanimal wounds and injuries
Nonvenomous bites

Workup

Laboratory Studies

  • CBC with manual differential and peripheral blood smear
  • Prothrombin time and activated partial thromboplastin time, international normalized ratio (INR).
  • Fibrinogen and split products
  • Type and cross
  • Blood chemistries, including electrolytes, BUN, creatinine
  • Urinalysis for myoglobinuria
  • Arterial blood gas determinations and/or lactate level for patients with systemic symptoms

Imaging Studies

  • Baseline chest radiograph in patients with pulmonary edema
  • Plain radiograph to rule out retained fang(s)

Other Tests

Compartmental pressures may need to be measured. Commercially available devices exist that are sterile, simple to assemble and read, and reliable (eg, the Stryker pressure monitor). Measurement of compartmental pressures is indicated when significant swelling is present, pain is out of proportion to examination, and if paresthesias are present in the affected limb.

Staging

Please see Treatment for discussion of grading envenomation.

More on Snake Envenomation Overview

Overview: Snake Envenomation Overview
Differential Diagnoses & Workup: Snake Envenomation Overview
Treatment & Medication: Snake Envenomation Overview
Follow-up: Snake Envenomation Overview
Multimedia: Snake Envenomation Overview
References
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References

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  2. Scharman EJ, Noffsinger VD. Copperhead snakebites: clinical severity of local effects. Ann Emerg Med. Jul 2001;38(1):55-61. [Medline].

  3. Sotelo N. Review of treatment and complications in 79 children with rattlesnake bite. Clin Pediatr (Phila). Jun 2008;47(5):483-9. [Medline].

  4. Corneille MG, Larson S, Stewart RM, et al. A large single-center experience with treatment of patients with crotalid envenomations: outcomes with and evolution of antivenin therapy. Am J Surg. Dec 2006;192(6):848-52. [Medline].

  5. Dart RC, Seifert SA, Boyer LV, et al. A randomized multicenter trial of crotalinae polyvalent immune Fab (ovine) antivenom for the treatment for crotaline snakebite in the United States. Arch Intern Med. Sep 10 2001;161(16):2030-6. [Medline].

  6. Lavonas EJ, Gerardo CJ, O'Malley G, et al. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med. Feb 2004;43(2):200-6. [Medline].

  7. Vohra R, Cantrell FL, Williams SR. Fasciculations after rattlesnake envenomations: a retrospective statewide poison control system study. Clin Toxicol (Phila). Feb 2008;46(2):117-21. [Medline].

  8. Richardson WH, Goto CS, Gutglass DJ, Williams SR, Clark RF. Rattlesnake envenomation with neurotoxicity refractory to treatment with crotaline Fab antivenom. Clin Toxicol (Phila). Jun-Aug 2007;45(5):472-5. [Medline].

  9. Cannon R, Ruha AM, Kashani J. Acute hypersensitivity reactions associated with administration of crotalidae polyvalent immune Fab antivenom. Ann Emerg Med. Apr 2008;51(4):407-11. [Medline].

  10. Cowles RA, Colletti LM. Presentation and treatment of venomous snakebites at a northern academic medical center. Am Surg. May 2003;69(5):445-9. [Medline].

  11. Holstege CP, Singletary EM. Images in emergency medicine. Skin damage following application of suction device for snakebite. Ann Emerg Med. Jul 2006;48(1):105, 113. [Medline].

  12. Hunsaker DM, Hunsaker JC 3rd, Clayton T, Spiller HA. Lethal envenomation: medicolegal aspects of snakebites and religious snake handlers in Kentucky: a report of three cases with comment on medical, legal, and public policy ramifications. J Ky Med Assoc. Nov 2005;103(11):542-56. [Medline].

  13. Jordan GH, Deitch EA, Britt LD. Management of Poisonous Snakebites. American College of Surgeons: Consensus statement. 1997.

  14. Kravitz J, Gerardo CJ. Copperhead snakebite treated with crotalidae polyvalent immune fab (ovine) antivenom in third trimester pregnancy. Clin Toxicol (Phila). 2006;44(3):353-4. [Medline].

  15. Kularatne SA, Kumarasiri PV, Pushpakumara SK, et al. Routine antibiotic therapy in the management of the local inflammatory swelling in venomous snakebites: results of a placebo-controlled study. Ceylon Med J. Dec 2005;50(4):151-5. [Medline].

  16. Lavonas EJ, Gerardo CJ, O'Malley G, et al. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med. Feb 2004;43(2):200-6. [Medline].

  17. Schmidt JM. Antivenom therapy for snakebites in children: is there evidence?. Curr Opin Pediatr. Apr 2005;17(2):234-8. [Medline].

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  19. Stewart RM, Page CP. Wounds, Bites, and Stings. Trauma. 1996;3:929-34.

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Further Reading

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Keywords

snakebite, snake bite treatment, snake envenomation, poisonous snakes, Crotalidae, Elapidae, pit vipers, rattlesnakes, copperheads, coral snakes, Crotalus, Sistrurus, Agkistrodon, Micrurus fulvius fulvius, Micrurus fulvius tenere, venom, antivenin

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Contributor Information and Disclosures

Author

Brian James Daley, MD, MBA, FACS, Associate Program Director, Professor, Department of Surgery, Division of Trauma and Critical Care, University of Tennessee School of Medicine
Brian James Daley, MD, MBA, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Chest Physicians, American College of Surgeons, American Medical Association, Association for Academic Surgery, Association for Surgical Education, Eastern Association for the Surgery of Trauma, Shock Society, Society of Critical Care Medicine, Southeastern Surgical Congress, and Tennessee Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Lisa Kirkland, MD, FACP, CNSP, MSHA, Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital
Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Daniel R Ouellette, MD, FCCP, Associate Professor of Medicine, Wayne State University School of Medicine; Consulting Staff, Pulmonary Disease and Critical Care Medicine Service, Henry Ford Health System
Daniel R Ouellette, MD, FCCP is a member of the following medical societies: American College of Chest Physicians and American Thoracic Society
Disclosure: Boehringer Ingleheim Honoraria Speaking and teaching; Pfizer Honoraria Speaking and teaching

CME Editor

Timothy D Rice, MD, Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, Saint Louis University School of Medicine
Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians
Disclosure: Nothing to disclose.

Chief Editor

Jonathan Adler, MD, Attending Physician, Department of Emergency Medicine, Massachusetts General Hospital; Division of Emergency Medicine, Harvard Medical School
Jonathan Adler, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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