Sea Snake Envenomation Workup

Updated: Dec 13, 2016
  • Author: Dimitrios Papanagnou, MD, MPH; Chief Editor: Joe Alcock, MD, MS  more...
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Workup

Laboratory Studies

Obtain arterial blood gas (ABG) measurements if the patient's respiratory status is questionable.

Myoglobinuria may be found on urinalysis, typically 3-6 hours following envenomation. The urine may test positive for protein and occult blood 1 hour before myoglobin is detected.

Creatine kinase (CK) level may be elevated secondary to muscle damage.

Serum glutamic-oxaloacetic transaminase (SGOT) level may be elevated secondary to muscle damage.

Electrolyte levels may reveal hyperkalemia from myonecrosis.

Assess blood urea nitrogen (BUN) and creatine levels to monitor renal function.

Obtain a CBC count. A leukocytosis higher than 20,000 cells/µL suggests significant envenomation.

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Imaging Studies

The following imaging studies may be useful:

  • Chest radiography: This is useful to exclude other causes of respiratory distress and is mandatory in patients requiring intubation and mechanical ventilation.
  • Soft tissue and bone films of the bitten extremity: Radiographs may reveal embedded fangs and/or underlying osseous injury.
  • Bedside ultrasonography: As ultrasonography is becoming a more useful adjunct to physical examination in the emergency department, bedside imaging may facilitate identifying retained fangs at the site of venomous inoculation.
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Other Tests

An electrocardiogram (ECG) is useful to look for signs of hyperkalemia, including peaked T waves, a widened QRS complex, or ventricular arrhythmias.

Before antivenom administration, if time permits, skin testing to assess for allergy to horse serum is indicated, but it is not mandatory if the patient is unstable. The results of skin testing are not completely reliable. Intradermal injection of 0.02-0.03 mL of a 1:10 dilution of normal horse serum is the most commonly described technique; however, the test is more accurate if a 1:10 dilution of actual reconstituted antivenom is used. Skin test results are positive if a wheal develops in 5-30 minutes.

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