Editing Snakebite (section)

== Signs and symptoms ==
[[File:Snake bite symptoms.png|thumb|upright=1.4|The most common symptoms of any kind of snake envenomation.<ref name=MedlinePlus/><ref>[http://www.health-care-clinic.org/diseases/snakebite.html Health-care-clinic.org – Snake Bite First Aid – Snakebite] {{webarchive|url=https://web.archive.org/web/20160116034305/http://www.health-care-clinic.org/diseases/snakebite.html |date=16 January 2016}} Retrieved on 21 mars, 2009</ref><ref>Snake bite image example at [http://www.mdconsult.com/das/patient/body/127551351-2/0/10041/8928_en.jpg MDconsult – Patient Education – Wounds, Cuts and Punctures, First Aid for] {{webarchive|url=https://web.archive.org/web/20160107214703/http://www.mdconsult.com/das/patient/body/127551351-2/0/10041/8928_en.jpg |date=7 January 2016}}</ref> However, there is vast variation in symptoms between bites from different types of snakes.<ref name="MedlinePlus">[https://www.nlm.nih.gov/MEDLINEPLUS/ency/article/000031.htm MedlinePlus – Snake bites] {{webarchive|url=https://web.archive.org/web/20101204102457/http://www.nlm.nih.gov/medlineplus/ency/article/000031.htm |date=4 December 2010}} From Tintinalli JE, Kelen GD, Stapcynski JS, eds. Emergency Medicine: A Comprehensive Study Guide. 6th ed. New York, NY: McGraw Hill; 2004. Update date: 27 February 2008. Updated by: Stephen C. Acosta, MD, Department of Emergency Medicine, Portland VA Medical Center, Portland, OR. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc. Retrieved on 19 mars, 2009</ref>]]

The most common first symptom of all snakebites is an overwhelming fear, which may contribute to other symptoms,  and may include [[nausea]] and [[vomiting]], [[diarrhea]], [[vertigo (medical)|vertigo]], [[fainting]], [[tachycardia]], and cold, clammy skin.<ref name="Gold2002" /><ref name="Kitchens1987">{{cite journal | vauthors = Kitchens CS, Van Mierop LH | title = Envenomation by the Eastern coral snake (Micrurus fulvius fulvius). A study of 39 victims | journal = JAMA | volume = 258 | issue = 12 | pages = 1615–1618 | date = September 1987 | pmid = 3625968 | doi = 10.1001/jama.258.12.1615}}</ref> Snake bites can have a variety of different signs and symptoms depending on their species.<ref name="Healthline Media UK Ltd" />

[[Dry bite|Dry snakebites]] and those inflicted by a non-venomous species may still cause severe injury. The bite may become infected from the snake's saliva. The fangs sometimes harbor pathogenic microbial organisms, including ''[[Clostridium tetani]]'', and may require an updated tetanus immunization.<ref>Otten E, Blomkalns A. Venomous animal injuries. In: Marx J, Hockberger R, Walls R, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. St Louis: Mosby; 2002</ref><ref name=Langley2020 />

Most snakebites, from either a venomous or a non-venomous snake, will have some type of local effect.<ref name="Online Khabar">{{cite web | vauthors = Lamsal S |title=Snakebites in Nepal are a medical emergency. Here are things you should know about them |url=https://english.onlinekhabar.com/snakebites-in-nepal-know-everything.html |date=3 June 2023 |website=[[Online Khabar]] |access-date=21 June 2023}}</ref> Minor pain and [[Erythema|redness]] occur in over 90 percent of cases, although this varies depending on the site.<ref name="Gold2002" /> Bites by [[Viper (animal)|vipers]] and some [[cobra]]s may be extremely painful, with the local tissue sometimes becoming tender and severely [[Edema|swollen]] within five minutes.<ref name=Gutierrez2007/> This area may also bleed and blister and may lead to tissue [[necrosis]]. Other common initial symptoms of [[pit viper]] and [[Viper (animal)|viper]] bites include lethargy, bleeding, weakness, nausea, and vomiting.<ref name="Gold2002" /><ref name=Gutierrez2007/> Symptoms may become more life-threatening over time, developing into [[hypotension]], [[tachypnea]], severe tachycardia, severe internal bleeding, altered [[sensorium]], [[kidney failure]], and [[respiratory failure]].<ref name="Gold2002" /><ref name=Gutierrez2007/>

Bites by some snakes, such as the [[kraits]], [[coral snake]], [[Mojave rattlesnake]], and the [[Crotalus mitchellii|speckled rattlesnake]], may cause little or no pain, despite their serious and potentially life-threatening venom.<ref name="Gold2002" /> Some people report experiencing a "rubbery", "minty", or "metallic" taste after being bitten by certain species of rattlesnake.<ref name="Gold2002" /> [[Spitting cobra]]s and [[rinkhals]]es can spit venom in a person's eyes. This results in immediate pain, [[ophthalmoparesis]], and sometimes [[blindness]].<ref name="Warrell1976">{{cite journal | vauthors = Warrell DA, Ormerod LD | title = Snake venom ophthalmia and blindness caused by the spitting cobra (Naja nigricollis) in Nigeria | journal = The American Journal of Tropical Medicine and Hygiene | volume = 25 | issue = 3 | pages = 525–529 | date = May 1976 | pmid = 1084700 | doi = 10.4269/ajtmh.1976.25.525}}</ref><ref name="Ismail1993">{{cite journal | vauthors = Ismail M, al-Bekairi AM, el-Bedaiwy AM, Abd-el Salam MA | title = The ocular effects of spitting cobras: I. The ringhals cobra (Hemachatus haemachatus) venom-induced corneal opacification syndrome | journal = Journal of Toxicology. Clinical Toxicology | volume = 31 | issue = 1 | pages = 31–41 | year = 1993 | pmid = 8433414 | doi = 10.3109/15563659309000372}}</ref>
[[File:Tissue necrosis following bite from Bothrops asper PLoS Medicine.jpg|thumb|left|upright|Severe [[tissue necrosis]] following ''[[Bothrops asper]]'' envenomation that required [[amputation]] above the knee. The person was an 11-year-old boy, bitten two weeks earlier in [[Ecuador]], but treated only with [[antibiotic]]s.<ref name="Gutierrez2006">{{cite journal | vauthors = Gutiérrez JM, Theakston RD, Warrell DA | title = Confronting the neglected problem of snake bite envenoming: the need for a global partnership | journal = PLOS Medicine | volume = 3 | issue = 6 | pages = e150 | date = June 2006 | pmid = 16729843 | pmc = 1472552 | doi = 10.1371/journal.pmed.0030150 | doi-access = free}}</ref>]]
Some Australian elapids and most viper envenomations will cause [[coagulopathy]], sometimes so severe that a person may bleed spontaneously from the mouth, nose, and even old, seemingly healed wounds.<ref name="Gutierrez2007" /> Internal organs may bleed, including the brain and intestines,<ref name="Cunha2021">{{cite web | url = https://www.emedicinehealth.com/snakebite/symptom.htm | title = Symptoms and Signs of Snakebite (Snake Bite) | last = Cuhna | first = John P. | publisher = [[WebMD]] | date= August 6, 2021 | website = [[eMedicine]]Health | access-date = July 26, 2022}}</ref> and [[ecchymosis]] (bruising) of the skin is often seen.<ref name="SmallAnimalToxicology">{{cite journal | last1 = Peterson | first1 = Michael E. | last2 = Talcott | first2 = Patricia A. | year = 2013 | title = Snake Bite: North American Pit Vipers | url = https://www.sciencedirect.com/science/article/pii/B9781455707171000752 | journal = Small Animal Toxicology | edition = 3rd | pages = 783–797 | doi = 10.1016/B978-1-4557-0717-1.00075-2 | isbn = 978-1-4557-0717-1| url-access = subscription }}</ref>

The venom of elapids, including [[sea snakes]], [[Bungarus|kraits]], [[Naja|cobras]], [[Ophiophagus hannah|king cobra]], [[Dendroaspis|mambas]], and many Australian species, contains toxins which attack the nervous system, causing [[neurotoxicity]].<ref name="Gold2002" /><ref name=Gutierrez2007/><ref name="Phillips2002">{{cite journal | vauthors = Phillips CM |year=2002 |title=Sea snake envenomation |journal=Dermatologic Therapy |volume=15 |issue=1 |pages=58–61(4) |doi=10.1046/j.1529-8019.2002.01504.x |s2cid=73275266 |url=http://www.kingsnake.com/aho/pdf/menu6/phillips2002.pdf |access-date=24 July 2009 |url-status=live |archive-url=https://web.archive.org/web/20110428095839/http://www.kingsnake.com/aho/pdf/menu6/phillips2002.pdf |archive-date=28 April 2011}}</ref> The person may present with strange disturbances to their vision, including blurriness. [[Paresthesia]] throughout the body, as well as difficulty in speaking and breathing, may be reported.<ref name="Gold2002" /> Nervous system problems will cause a huge array of symptoms, and those provided here are not exhaustive. If not treated immediately they may die from [[respiratory failure]].<ref name="ManagementofRespiratoryFailure">{{cite journal |last1 = Sabirin |first1 = Mira R |last2 = Sudjud |first2 = Reza W |last3 = Suwarman |first3 = Suwarman |last4 = Pradian |first4 = Erwin |date = August 18, 2020 |title = Management of Respiratory Failure Following Snake Bite |journal = Journal of Health and Medical Sciences |volume = 3 |issue = 3 |pages = 338–349 |doi = 10.31014/aior.1994.03.03.129 |s2cid = 224885423 |url = https://ssrn.com/abstract=3676254 |issn = 2622-7258 |access-date=July 27, 2022 |url-status = live |archive-url = https://web.archive.org/web/20220727124831/https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3676254 |archive-date = July 27, 2022}}</ref>

Venom emitted from some types of cobras, almost all vipers, and some sea snakes cause [[necrosis]] of muscle tissue.<ref name="Gutierrez2007" /> Muscle tissue will begin to die throughout the body, a condition known as [[rhabdomyolysis]].  Rhabdomyolysis can result in damage to the kidneys as a result of myoglobin accumulation in the renal tubules. This, coupled with [[hypotension]], can lead to [[acute kidney injury]], and, if left untreated, eventually death.<ref name="Gutierrez2007" />

Snakebite is also known to cause depression and post-traumatic stress disorder in a high proportion of people who survive.<ref>{{cite journal | vauthors = Bhaumik S, Kallakuri S, Kaur A, Devarapalli S, Daniel M | title = Mental health conditions after snakebite: a scoping review | journal = BMJ Global Health | volume = 5 | issue = 11 | pages = e004131 | date = November 2020 | pmid = 33257419 | pmc = 7705584 | doi = 10.1136/bmjgh-2020-004131}}</ref>