Brown Snake Envenomation Clinical Presentation

  • Author: David Cheng, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Apr 20, 2011
 

History

The bites of Pseudonaja frequently occur on the extremities, mostly on the fingers and feet, because collectors handle them or people accidentally step on them. Unfortunately, unless the patient gives a history of being bitten by a snake, local clues to the evidence of a bite may be subtle or absent because brown snake bites cause little or no local swelling or pain. After giving a history of being bitten by a brown-colored snake, the patient may complain of neurological symptoms within an hour; the symptomatology within a few hours may manifest with a coagulopathy and signs of diaphragmatic paralysis and cardiovascular compromise. The following symptoms may be present:

  • Headache
  • Nausea and vomiting
  • Weakness
  • Photophobia
  • Irritability
  • Diplopia
  • Altered mental status
  • Dyspnea
  • Epistaxis
  • Gingival bleeding
  • Hematemesis
  • Hematochezia
  • Oliguria
  • Dysphagia
Next

Physical

  • Fang marks
  • Little to no local edema or erythema
  • Bronchospasm
  • Ptosis
  • Trismus
  • Seizures
  • Respiratory muscle weakness to apnea
  • Cyanosis
  • Paralysis
  • Hypotension
  • Tachycardia or bradycardia
  • Cardiac arrest
  • Epistaxis
  • Hematemesis
  • Hematochezia
  • Petechia
  • Purpura
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Contributor Information and Disclosures
Author

David Cheng, MD  Associate Professor of Emergency Medicine, Education Director, Associate Emergency Medicine Residency Director, Case Medical Center

David Cheng, MD is a member of the following medical societies: American College of Emergency Physicians, American Heart Association, Council of Emergency Medicine Residency Directors, International Society for Mountain Medicine, National Association of EMS Physicians, Society for Academic Emergency Medicine, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Daniel J Dire, MD, FACEP, FAAP, FAAEM  Clinical Professor, Department of Emergency Medicine, University of Texas Medical School at Houston; Clinical Professor, Department of Pediatrics, University of Texas Health Sciences Center San Antonio

Daniel J Dire, MD, FACEP, FAAP, FAAEM is a member of the following medical societies: American Academy of Clinical Toxicology, American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, and Association of Military Surgeons of the US

Disclosure: Nothing to disclose.

John T VanDeVoort, PharmD  Regional Director of Pharmacy, Sacred Heart and 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.

David Eitel, MD, MBA  Associate Professor, Department of Emergency Medicine, York Hospital; Physician Advisor for Case Management, Wellspan Health System, York

David Eitel, MD, MBA is a member of the following medical societies: American College of Emergency Physicians, American Society of Pediatric Nephrology, Society for Academic Emergency Medicine, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

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

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

Additional Contributors

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

References

  1. O'Leary MA, Isbister GK, Schneider JJ, Brown SG, Currie BJ. Enzyme immunoassays in brown snake (Pseudonaja spp.) envenoming: detecting venom, antivenom and venom-antivenom complexes. Toxicon. Jul 2006;48(1):4-11. [Medline].

  2. Yeung JM, Little M, Murray LM, Jelinek GA, Daly FF. Antivenom dosing in 35 patients with severe brown snake (Pseudonaja) envenoming in Western Australia over 10 years. Med J Aust. Dec 6-20 2004;181(11-12):703-5. [Medline].

  3. Brown SG, Caruso N, Borland ML, McCoubrie DL, Celenza A, Isbister GK. Clotting factor replacement and recovery from snake venom-induced consumptive coagulopathy. Intensive Care Med. Sep 2009;35(9):1532-8. [Medline].

  4. Isbister GK, Brown SG, MacDonald E, White J, Currie BJ. Current use of Australian snake antivenoms and frequency of immediate-type hypersensitivity reactions and anaphylaxis. Med J Aust. Apr 21 2008;188(8):473-6. [Medline].

  5. Brimacombe J, Murray A. Envenomation by Ingram's Brown snake (Pseudonaja ingrami). Anaesth Intensive Care. Apr 1995;23(2):231-3. [Medline].

  6. Broad AJ, Sutherland SK, Coulter AR. The lethality in mice of dangerous Australian and other snake venom. Toxicon. 1979;17(6):661-4. [Medline].

  7. Buckley N, Dawson AH. Unusual results of brown snake envenomation. Med J Aust. Jun 21 1993;158(12):866-8. [Medline].

  8. Currie BJ. Snakebite in tropical Australia: a prospective study in the "Top End" of the Northern Territory. Med J Aust. Dec 6-20 2004;181(11-12):693-7. [Medline].

  9. Henderson A, Baldwin LN, May C. Fatal brown snake (Pseudonaja textilis) envenomation despite the use of antivenom. Med J Aust. May 17 1993;158(10):709-10. [Medline].

  10. Hodgson WC. Pharmacological action of Australian animal venoms. Clin Exp Pharmacol Physiol. Jan 1997;24(1):10-7. [Medline].

  11. Isbister GK, O'Leary MA, Schneider JJ, Brown SG, Currie BJ; ASP Investigators. Efficacy of antivenom against the procoagulant effect of Australian brown snake (Pseudonaja sp.) venom: in vivo and in vitro studies. Toxicon. Jan 2007;49(1):57-67. [Medline].

  12. Masci PP, Mirtschin PJ, Nias TN, et al. Brown snakes (Pseudonaja genus): venom yields, prothrombin activator neutralization and implications affecting antivenom usage. Anaesth Intensive Care. Jun 1998;26(3):276-81. [Medline].

  13. Munro JG, Pearn JH. Snake bite in children: a five year population study from South-East Queensland. Aust Paediatr J. Dec 1978;14(4):248-53. [Medline].

  14. Pantanowitz L, Guidozzi F. Management of snake and spider bite in pregnancy. Obstet Gynecol Surv. Oct 1996;51(10):615-20. [Medline].

  15. Ripamonti C, De Conno F, Boffi R, et al. Can somatostatin be administered in association with morphine in advanced cancer patients with pain?. Ann Oncol. Aug 1998;9(8):921-3. [Medline].

  16. Schapel GJ, Utley D, Wilson GC. Envenomation by the Australian common brown snake--Pseudonaja (Demansia) textilis textilis. Med J Aust. Jan 16 1971;1(3):142-4. [Medline].

  17. Sprivulis P, Jelinek GA. Fatal intracranial haematomas in two patients with Brown snake envenomation. Med J Aust. Feb 20 1995;162(4):215-6. [Medline].

  18. Sutherland SK. Concern over the choice of antivenom for "false king brown snake" bites and a plea for a name change. Med J Aust. Feb 15 1999;170(4):187. [Medline].

  19. Sutherland SK. Venomous Creatures of Australia. Oxford University Press; 1981.

  20. Sutherland SK, Leonard RL. Snakebite deaths in Australia 1992-1994 and a management update. Med J Aust. Dec 4-18 1995;163(11-12):616-8. [Medline].

  21. Tibballs J, Sutherland S, Kerr S. Studies on Australian snake venoms. Part 1: The haemodynamic effects of brown snake (Pseudonaja) species in the dog. Anaesth Intensive Care. Nov 1989;17(4):466-9. [Medline].

  22. Tibballs J, Sutherland SK, Kerr S. Studies on Australian snake venoms, Part II: The haematological effects of brown snake (Pseudonaja) species in the dog. Anaesth Intensive Care. Aug 1991;19(3):338-42. [Medline].

  23. Walter FG, Bilden EF, Gibly RL. Envenomations. Crit Care Clin. Apr 1999;15(2):353-86, ix. [Medline].

  24. White J. Envenoming and antivenom use in Australia. Toxicon. Nov 1998;36(11):1483-92. [Medline].

 
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Pseudonaja guttata (speckled brown snake).
Pseudonaja textilis (eastern brown snake).
Pseudonaja modesta (ringed brown snake).
Pseudonaja nuchalis (western brown snake).
 
 
 
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