eMedicine Specialties > Emergency Medicine > Environmental

Snake Envenomation, Sea: Follow-up

Author: Dimitrios Papanagnou, MD, MPH, Staff Physician, Department of Emergency Medicine, Bellevue Hospital Center
Coauthor(s): Susi U Vassallo, MD, FACEP, FACMT, Assistant Professor of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center
Contributor Information and Disclosures

Updated: Nov 6, 2008

Follow-up

Further Inpatient Care

  • Manage all symptomatic sea snake envenomations on an inpatient basis. Given the potentially serious nature of envenomation and the risks associated with antivenin administration, most patients require admission to an intensive care unit.
  • Monitor patients treated with antivenom for allergic reactions and treat appropriately.

Further Outpatient Care

  • Before discharge, describe the signs and symptoms of delayed serum sickness to patients who receive antivenom and advise them to seek prompt medical care if any such symptoms occur.
  • Patients who are asymptomatic (ie, experience no pain with passive muscle movement 2 hours after a sea snake bite) are extremely unlikely to have experienced a significant envenomation and may be safely discharged with close follow-up monitoring. However, patients may have delayed symptoms if the bite site was immobilized and treated with a pressure bandage or venous tourniquet, and they should be observed in the hospital.

Transfer

  • Transfer is appropriate if it is required to provide antivenom administration, intensive monitoring, or critical care that is not available at the institution to which the patient initially presents.

Deterrence/Prevention

  • Patients should avoid waters known to harbor sea snakes.
  • Patients should avoid approaching, handling, or provoking sea snakes.
  • Children playing or swimming in waters within the typical geographic ranges of sea snakes should be carefully supervised.

Complications

Complications of sea snake envenomation may include the following:

  • Respiratory failure
  • Cardiovascular collapse and shock
  • Allergic reactions (eg, anaphylaxis), in response to sea snake envenomation or antivenom administration
  • Serum sickness following antivenom administration (usually between 5 d and 3 wk), characterized by urticaria, fever, lymphadenopathy, and arthritis
  • Renal failure, most commonly due to necrosis in the distal tubules
  • Hyperkalemia
  • Dysrhythmias (secondary to hyperkalemia)

Prognosis

  • Although sea snake venoms contain extremely potent toxins, as many as 80% of sea snake bites do not produce clinically significant envenomation. Therefore, the overall prognosis for people bitten by sea snakes is good.
  • Before the development of antivenom, the mortality rate associated with sea snake bites was approximately 10% overall but approximately 50% for clinically significant envenomations. With antivenom administration and aggressive supportive care, the mortality rate is significantly reduced.
  • In fatal cases, death has been reported as early as 2.5 hours and as late as 24 days after envenomation.

Patient Education

  • In areas with endemic sea snake populations, public education about the identification and avoidance of sea snakes may be useful.

Miscellaneous

Medicolegal Pitfalls

  • Because of the relatively small size of sea snake fangs and the relative lack of local irritation, the diagnosis of envenomation may be inadvertently missed or patients may be prematurely discharged before serious symptoms occur.
  • Respiratory distress should be managed aggressively to prevent aspiration and hypoxemia.
  • Allergic reactions may occur in response to antivenom administration and may be life threatening. Informed consent should be obtained before administration, unless the patient is in extremis or unable to provide consent.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, James Foster, MD, to the development and writing of this article.



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References
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References

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Further Reading

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Keywords

sea snake envenomation, sea snake bite, sea snakes, snake bite, Hydrophiidae, Pelamis platurus, P platurus, Enhydrina schistosa, E schistosa, sea snake venom, neurotoxins, myotoxins, snake envenomations, sea snake neurotoxin, sea snake wound

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Contributor Information and Disclosures

Author

Dimitrios Papanagnou, MD, MPH, Staff Physician, Department of Emergency Medicine, Bellevue Hospital Center
Dimitrios Papanagnou, MD, MPH is a member of the following medical societies: American College of Emergency Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Student Association/Foundation, and Emergency Medicine Residents Association
Disclosure: Nothing to disclose.

Coauthor(s)

Susi U Vassallo, MD, FACEP, FACMT, Assistant Professor of Emergency Medicine, New York University School of Medicine/Bellevue Hospital Center
Susi U Vassallo, MD, FACEP, FACMT is a member of the following medical societies: American Academy of Clinical Toxicology, American College of Emergency Physicians, American College of Medical Toxicology, New York Academy of Medicine, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Robert L Norris, MD, Associate Professor, Department of Surgery; Chief, Division of Emergency Medicine, Stanford University Medical Center
Robert L Norris, MD is a member of the following medical societies: American College of Emergency Physicians, American Medical Association, California Medical Association, International Society of Toxinology, Society for Academic Emergency Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

John T VanDeVoort, PharmD, Regional Director of Pharmacy, Sacred Heart & St. Joseph's Hospitals
John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
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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