Dawaa Reference

acute

Snake Bite

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources2 sources

WHO Snakebite envenoming - treatment (Control of Neglected Tropical Diseases, who.int) · MSF Essential Drugs 2024 - paracetamol (oral)

Verified against3 documents
  • WHO Snakebite envenoming - treatment (Control of Neglected Tropical Diseases, who.int)
  • Snake Bite - disease-level clinical article (snake-bite-clinical.txt)
  • MSF Essential Drugs 2024 - paracetamol (oral)

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (1)

  • Nausea, vomiting, belly pain, lethargy, muscle weakness or twitching, and severe headache can mark systemic envenomation [abdominal pain · headache · lethargy · muscle weakness · nausea · vomiting]

Signs — what you find (7)

  • Fang marks at the bite site may or may not be visible on exam
  • Local tissue injury can show bruising, blistering, or outright necrosis [bruising · necrosis]
  • Neurotoxic envenomation starts with generalized weakness, drooping eyelids, and eye-movement paralysis, progressing to facial paralysis and respiratory failure [paralysis]
  • Active bleeding from the bite wound, nosebleeds, or spontaneous bleeding suggest a hemotoxic bite [bleeding · nosebleed]
  • Shock from venom can arise via vasodilation, low blood volume, or anaphylaxis [shock]
  • Elapid bites cause little local damage but a neurotoxic syndrome with systemic toxicity, pointing to that snake family
  • Viperid bites cause severe local tissue damage with a hemotoxic syndrome and systemic toxicity

Tests (6)

  • Suspected hemotoxin exposure calls for CBC, prothrombin time, partial thromboplastin time, and fibrinogen
  • Creatine kinase, electrolytes, and urinalysis screen for muscle breakdown and kidney involvement
  • Neurotoxicity is followed with end-tidal CO2 monitoring or serial arterial blood gases for evolving respiratory acidosis
  • Rapid venom testing can confirm a suspected snake species, but a negative result cannot rule one out
  • The bite site is watched closely for spreading swelling, blisters, or compartment syndrome
  • A direct compartment pressure over 30 mm Hg confirms early compartment syndrome

If not this — what else fits (5)

  • Without a witnessed snake bite, scorpion, tick, or spider bites are regional alternatives
  • Guillain-Barre syndrome is a consideration when the pattern is neurotoxic
  • Tick paralysis can mimic the same neurotoxic picture
  • Unexplained coagulopathy warrants work-up for a hereditary cause or an acquired disease such as DIC or ITP
  • Local tissue destruction can instead stem from trauma or a soft-tissue infection like cellulitis, abscess, or necrotizing fasciitis

SourceStatPearls "Evaluation and Treatment of Snake Envenomations" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Pain relief during transfer - not treatment of the envenoming

MAIN TREATMENT

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

Immobilize the bitten limb (splint), keep patient completely still, and arrange immediate emergency transport to a hospital equipped with antivenom - Immediate emergency transfer

Paediatric dose

Immediate emergency pediatric transport

Dose source

WHO Snakebite envenoming - treatment (Control of Neglected Tropical Diseases, who.int)

Why

Primary care in Egypt rarely stocks appropriate polyvalent antivenom; immediate transfer is life-saving.

Cautions
  • DO NOT apply a tourniquet.
  • DO NOT incise, cut, or apply suction to the bite wound.
  • DO NOT apply ice or heat to the area.
  • Remove rings or constricting items before swelling occurs.
  • RED FLAG - Before hospital arrival, do NOT incise the wound, attempt oral or suction venom removal, apply ice, or give alcohol. Immobilize, keep the patient still, and transfer.
  • RED FLAG - Explicit warnings against dangerous lay first-aid practices (tourniquets, venom extractors, wound incision/washout) that increase morbidity are missing from the advice
  • RED FLAG - SEVERE SYSTEMIC ENVENOMING PARALYSES THE BREATHING MUSCLES. Deepening weakness, a drooping eyelid, difficulty swallowing or speaking, and shallow or failing breathing mean the diaphragm is going. That patient needs an airway and ventilation on the way to antivenom, and no analgesic addresses any part of it.

PAIN RELIEF DURING TRANSFER - NOT TREATMENT OF THE ENVENOMING - give alongside

2

PARACETAMOL

Pain relief during transfer - not treatment of the envenoming

add-on - not a substitute

Strength500 mg

Formoral.solid

Adult dose and duration

1 g three or four times daily, maximum 4 g in 24 hours - For the local pain, while the patient is being moved to a hospital that holds antivenom

Paediatric dose

15 mg/kg/dose [child max 500 mg]

(A child of 1 month and over takes 15 mg/kg per dose, 3 or 4 times daily, to a maximum of 60 mg/kg daily; under 1 month it is 10 mg/kg per dose, 3 or 4 times daily, to a maximum of 40 mg/kg daily. A bitten child is at greater risk than a bitten adult from the same bite, because the same quantity of venom is distributed through a smaller body - the urgency of transport rises accordingly, and the analgesic does not change that.)

Dose by weight
3kg45 mg/dose
4kg60 mg/dose
5kg75 mg/dose
6kg90 mg/dose
7kg105 mg/dose
8kg120 mg/dose
9kg135 mg/dose
10kg150 mg/dose
11kg165 mg/dose
12kg180 mg/dose
13kg195 mg/dose
14kg210 mg/dose
15kg225 mg/dose
16kg240 mg/dose
17kg255 mg/dose
18kg270 mg/dose
19kg285 mg/dose
20kg300 mg/dose
21kg315 mg/dose
22kg330 mg/dose
23kg345 mg/dose
24kg360 mg/dose
25kg375 mg/dose
26kg390 mg/dose
27kg405 mg/dose
28kg420 mg/dose
29kg435 mg/dose
30kg450 mg/dose
31kg465 mg/dose
32kg480 mg/dose
33kg495 mg/dose
34kg500 mg/dose (capped)
35kg500 mg/dose (capped)
36kg500 mg/dose (capped)
37kg500 mg/dose (capped)
38kg500 mg/dose (capped)
39kg500 mg/dose (capped)
40kg500 mg/dose (capped)
41kg500 mg/dose (capped)
42kg500 mg/dose (capped)
43kg500 mg/dose (capped)
44kg500 mg/dose (capped)
45kg500 mg/dose (capped)
46kg500 mg/dose (capped)
47kg500 mg/dose (capped)
48kg500 mg/dose (capped)
49kg500 mg/dose (capped)
50kg500 mg/dose (capped)
Dose source

MSF Essential Drugs 2024 - paracetamol (oral)

Why

Two documents, each for a different claim. The WHO snakebite envenoming treatment page, already cited on the card, names the drug: its first-aid box states that paracetamol may be given for local pain, alongside immobilising and splinting the limb and moving the patient to a health facility as soon as possible. It gives no amount, so the amount comes from the MSF monograph for the same drug. Paracetamol is here for the pain of the bite and for nothing else - it does not touch the venom, and giving it must not slow the journey to antivenom.

Cautions
  • ANTIVENOM IS THE TREATMENT AND IT IS NOT IN THIS CLINIC. WHO states that early administration of an adequate dose of effective antivenom is crucial in a patient with signs of envenoming, and gives no milligram figure - antivenom is dosed in vials, against the venom rather than against body weight, and by the receiving hospital. In Egypt it is supplied through the Ministry of Health and hospital pharmacy, which is why no Egyptian retail product is listed for it here.
  • PARACETAMOL IS THE ANALGESIC WHO NAMES, AND THE ONLY ONE. The article records that these bites can cause a consumptive coagulopathy with defibrination and a bleeding tendency - spontaneous bleeding, nosebleeds, or bleeding from the puncture site are signs of a haemotoxic effect - and that these coagulopathies usually settle within 48 hours of the envenoming.
  • DO NOT APPLY A TOURNIQUET. The article states that a tourniquet proximal to the bite gives higher morbidity with no improvement in outcome, and WHO's own instruction is never to use a tight arterial tourniquet.
  • DO NOT CUT, WASH OUT OR SUCK THE WOUND. The article does not suggest incision or washout, and WHO asks that traditional first aid, herbal remedies and other unproven methods be avoided.
  • WHAT TO DO INSTEAD: immobilise the person completely and splint the limb to keep it still, control any bleeding with direct pressure, place an unconscious patient on their left side in the recovery position to protect the airway, and transport to a health facility as fast as possible.
  • Check every other product the patient is taking for paracetamol - Egyptian combination cold and flu preparations are the usual route to an accidental overdose. Reduce the dose in significant liver disease, chronic alcohol use, or low body weight.
Egyptian brands
Egyptian brandManufacturerIndicative price
FEBRIMOL 500 MG 20 TAB.PHARCO3.50 EGP (0.17/unit)
CETAMOL 500 MG 20 TABS.MEMPHIS8.00 EGP (0.40/unit)
PARACETAMOL-MUP 500MG B.P. 20 TABS.MUP13.00 EGP (0.65/unit)
CETAL 500 MG 20 TABS.EIPICO24.00 EGP (1.20/unit)
ARKADOLOW 500 MG 30 F.C. TABS.UTOPIA42.00 EGP (1.40/unit)
PARAMOL 500MG 20 TAB.MISR38.00 EGP (1.90/unit)
ADOL 500MG 24 CAPLETSJULPHAR32.00 EGP
AUGICETAMIDE 500 MG 20 SACHETSAUG PHARMA50.00 EGP
FEBRIMOL ORAL DROPS 20 ML? strength differs? different route - not oral solidPHARCO4.00 EGP
THERA-LO 3.2G/100ML ORAL SUSP. 100 ML? strength differs? different route - not oral solidPHAROPHARMA5.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.