Brown Snake Envenomation Follow-up

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

Further Inpatient Care

  • Admit any person who has been bitten by a brown snake to an intensive care unit.
  • Because of the potential lethality of this toxin and since symptoms may be delayed, observe asymptomatic patients in an ICU setting for at least 24 hours.
  • Corticosteroids and antihistamines should be continued for at least 5 days.
Next

Further Outpatient Care

  • Warn patient of potential serum sickness.
  • Instruct patient to return if serum sickness develops.
  • Follow up patient closely.
Previous
Next

Transfer

  • Transfer patient to facility capable of intensive care monitoring; and, in case patient develops renal failure and hemodialysis, arrange for transportation to facility with dialysis capabilities.
Previous
Next

Deterrence/Prevention

  • Professional snake keepers should wear protective gloves when handling all brown snakes.
  • The appropriate antivenin must be readily available.
  • Wear long pants and covered shoes when traveling to areas inhabited by venomous snakes.
  • Avoid approaching or handling snakes, even dead snakes.
  • Travel with a companion in case any disability from a snakebite occurs, and be aware of the locations of the nearest medical facilities.
Previous
Next

Complications

Previous
Next

Prognosis

  • If no systemic symptoms are present, recovery is expected.
  • Since the development of antivenin and the use of compression bandages, fatalities from brown snake bites have become rare. However, in spite of prompt medical care and antivenin administration, the potency of the venom has produced fatalities.
Previous
Next

Patient Education

  • The public should be aware of the danger of being bitten by a brown snake so vigilance may be exercised when traveling or when owning such a snake.
  • Because of the potency of the snake venom, the public should not delay seeking medical care.
  • For excellent patient education resources, visit eMedicine's Bites and Stings Center. Also, see eMedicine's patient education article Snakebite.
Previous
 
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].

 
Previous
Next
 
Pseudonaja guttata (speckled brown snake).
Pseudonaja textilis (eastern brown snake).
Pseudonaja modesta (ringed brown snake).
Pseudonaja nuchalis (western brown snake).
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.