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:
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Headache
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Nausea and vomiting
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Weakness
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Photophobia
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Irritability
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Diplopia
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Altered mental status
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Dyspnea
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Epistaxis
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Gingival bleeding
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Hematemesis
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Hematochezia
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Oliguria
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Dysphagia
Physical Examination
Physical examination findings include the following:
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Fang marks with coagulopathy
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Little to no local edema or erythema
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Bronchospasm
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Ptosis
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Trismus
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Seizures
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Respiratory muscle weakness to apnea
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Cyanosis
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Paralysis
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Hypotension
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Tachycardia or bradycardia
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Cardiac arrest
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Epistaxis
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Hematemesis
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Hematochezia
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Petechia
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Purpura
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Cerebellar hemorrhage [6]
Complications
Complications may include the following:
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Seizures
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Intracranial hemorrhage - Within 3-12 h of envenomation; elderly persons and those with hypertension predisposed [7]
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Respiratory compromise
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Weakness
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Bleeding diathesis
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Secondary infections
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Anaphylactoid and serum sickness reactions [8]
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Pseudonaja guttata (speckled brown snake).
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Pseudonaja textilis (eastern brown snake).
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Pseudonaja modesta (ringed brown snake).
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Pseudonaja nuchalis (western brown snake).