ICU · Toxicology

Snake envenomation in the ICU

Also known as Snake bite · Envenomation · Polyvalent antivenom · Venom-induced consumption coagulopathy (VICC)

Snake envenomation is a significant problem in Australia, Asia, Africa, and South America. Australian snakes: brown snake (most deaths), tiger snake, taipan, death adder, mulga/black snake. Clinical syndromes: (1) COAGULOPATHY (VICC — venom-induced consumption coagulopathy — prothrombin activator consuming fibrinogen and factors V/VIII; INR and aPTT beyond assay limits; platelets normal; resolution within 24–36 h). (2) NEUROTOXICITY (presynaptic — taipan, tiger — irreversible terminal damage; postsynaptic — death adder — curare-like blockade; ASP-16: neurotoxicity NOT reversed by antivenom, which prevents progression). (3) MYOTOXICITY (rhabdomyolysis — raised CK, myoglobinuria, AKI). (4) RENAL: AKI (12% of envenoming; TMA subset). (5) LOCAL: bite site swelling, bruising, necrosis. Diagnosis: snake venom detection kit (SVDK — bite site swab or urine — identifies snake GROUP; 4.9% incorrect in envenomed, 36% false positives in non-envenomed) and the 20-minute whole blood clotting test. Management: pressure immobilisation bandage (FIRST AID — slows lymphatic spread), IV antivenom (one vial binds all circulating venom), supportive ICU (ventilation for neurotoxicity, RRT for AKI, blood products for bleeding from VICC).

Checked against its sources on 2 Sept 2026