Clinical diagnosis and management of venomous snake bite caused by Death Adder

(Acanthopus, sp.) : a case report.

Andrio Palayukan1, Agnes Suwanto1

1
General practitioner, Mitra Masyarakat Hospital, Indonesia

Objective
Snake bite is one of the most neglected public health issues in poor rural communities
living in the tropics. Because of serious misreporting, the true worldwide burden of
snake bite is not known.1 The diagnosis and treatment of venomous snake bites is
sometimes difficult for clinicians because sufficient information has not been
provided in clinical practice.2 This case report aimed at presenting a snake bite
envenoming case of a woman in Mitra Masyarakat Hospital, Papua, Indonesia.

Case Report
A 45 years old native Papua woman was brought to the emergency department 1 hour
after a snake bite to the left lower leg. Patient complained of pain around the
snakebite wound. She came to the hospital while carrying the biting snake, which was
identified as Death Adder. From the physical examination, there was a snakebite
wound on the left lower leg without any swelling around it. Her blood was taken for
further examination. The snakebite wound and the surrounding area then cleaned, her
left lower leg then being immobilized. One hour later, she developed envenoming
signs: altered consciousness status, ptosis, blurred vision, headache, and
hypersalivation. Blood pressure was 100/70 mmHg, heart rate was 108/minute,
respiratory rate was 24/minute and the temperature was 36.5oC. The oxygen was
given via nasal cannula. Before administering of Polyvalent Antivenom, 20 mg of
diphenhydramine and 10 mg of dexamethasone were given intravenously as
premedication. After that, Polyvalent Antivenom was administered to the patient for
30 minutes. Foley catheter was also installed. The patient was being observed
clinically (vital and envenoming signs) every 10 minutes. After one hour of
Polyvalent Antivenom administration, the envenoming signs disappeared. The
laboratory result: Haemoglobin 12.5 g/dL, leukocyte 14.940/mm3, platelet
214.000/mm3, bleeding time 2 seconds, clotting time 4 seconds, ureum 32 mg/dL and
creatinine 0.8 mg/dL. The patient then referred to the ward. The wound was cleaned
once a day. Antibiotic, analgetic and corticosteroid were also given. After 2 days of
observation, the patient was discharged.

Conclusion
Snake bites can cause rapidly developing clinical symptoms. Observation during
treatment should be conducted periodically. Quick and precise handling result in good
output. Antivenom therapy is warranted for venomous snake bites.

References:
1. Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake Bite in South
Asia: A Review. de Silva J, ed. PLoS Neglected Tropical Diseases.
2010;4(1):e603.
2. Sakai A. Diagnosis and treatment of snakebite by Mamushi and
Yamakagashi. Chudoku Kenkyu. 2013;26:193–9