SAQ 185 – Paediatric Toxicology – snake bite envenomation
Model Answer
Question 1. snake bite envenomation.
a. Immediate management
- Keep the child immobile.
- Apply a pressure-immobilisation bandage to the right lower limb.
- Splint the right lower limb.
- Obtain IV access and collect blood.
- Reassure the child and father.
b. Symptoms and signs
- Symptoms: headache, abdominal pain, vomiting, myalgia, diarrhoea, or sweating.
- Signs: neurotoxicity, bruising or bleeding, hypotension or circulatory failure, lymphadenopathy, or muscle tenderness.
c. Venom detection
- Use a bite-site skin swab.
- It has the best sensitivity and specificity; blood and urine have unacceptable false-positive or false-negative rates.
d. Blood tests
- Coagulation screen including INR, APTT, fibrinogen, and D-dimer.
- Blood film.
- Creatine kinase.
- LDH.
- Liver function tests.
e. Antivenom choices
| Management step | Variable | Justification |
|---|---|---|
| Antivenom type | Polyvalent if severe or uncertain; monovalent after venom-detection or area-specific identification. | Provides appropriate coverage while identification is uncertain. |
| Antivenom dose | One ampoule; seek toxicology advice regarding repeat or total dose. | Children receive the adult dose because venom load is not weight based. |
| Likelihood of serum sickness | Higher than in adults, particularly after polyvalent or larger total doses. | Risk increases with the amount of antivenom administered. |
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