Clinical features: Contact with snakes, scorpions and other insects result in two types of injuries: those due to direct effect of venom on victim and those due to indirect effect of poison e.g. hypersensitivity reaction to bee sting.

Less than 10% of 3500 snake species are poisonous and they include cobras and mambas (Elapidac) sea snakes (hydrophidac) and the boomslang and vine snakes (columbidac). It is a common problem in Tanzania. Clinical condition depends on the type of snake bite and amount of poison (venom) injected. Hence envenomation (poisoning) will be neurotoxic in cobra and mambas and sea snakes and haemotoxic in vipers and boomslang.

Treatment Guidelines

• Reassure the patient

• Clean bitten site with clean water to remove any poison and remove any fangs

• Remove any tourniquets and assess degree of envenomation. By vipers rapid swelling for 24 hours. In severe envenomation by vipers rapid leg swelling from hemorrhage into anterior compartment of lower limb may contain as much as 2 units of blood.

• Rarely will there be need to use specific antivenom.

• When indicated (by the degree of envenomation) use polyvalent anti-snakes venom (PAV)

• Infuse 80-100 ml of (PAV) diluted in 500 mL normal saline and start drip very slowly.

• Watch for hypersensitivity reaction and be prepared with already drawn out 100 mg hydrocortisone and Adrenaline. If reaction occurs, stop drip and give Hydrocortisone and Adrenaline and re-start drip after I hour and again watch for reaction.

• DOSE of polyvalent serum will depend on degree of envenomation. Same for both adults and children. The SAMRI variety of polyvalent is best compared to others. Use polyvalent since often the type of snake is unknown. There are specific monovalent sera where type of snake is known.

• Analgesics, antihistamines, blood letting are all obsolete. With reassurance, competent clinical observation, very few cases need active treatment since envenomation is rare.

• Snake venom spat into eyes must be washed thoroughly with water.