{ "schema_version": 1, "kind": "condition", "id": "snake-bite", "name": "Snake Bite", "category": "acute", "sources": "WHO Snakebite envenoming - treatment (Control of Neglected Tropical Diseases, who.int) · MSF Essential Drugs 2024 - paracetamol (oral)", "review_status": "reviewed", "verified_against": "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_date": "2026-08", "treatments": [ { "id": 1717, "generic": "Referral & safety-netting (no drug therapy)", "line": 1, "is_adjunct": false, "form": null, "strength_mg": null, "adult_dose": "Immobilize the bitten limb (splint), keep patient completely still, and arrange immediate emergency transport to a hospital equipped with antivenom", "adult_duration": "Immediate emergency transfer", "dose_source": "WHO Snakebite envenoming - treatment (Control of Neglected Tropical Diseases, who.int)", "rationale": "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." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Immediate emergency pediatric transport", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [], "condition_id": "snake-bite" }, { "id": 1716, "generic": "Paracetamol", "line": 1, "is_adjunct": true, "form": "oral.solid", "strength_mg": 500.0, "adult_dose": "1 g three or four times daily, maximum 4 g in 24 hours", "adult_duration": "For the local pain, while the patient is being moved to a hospital that holds antivenom", "dose_source": "MSF Essential Drugs 2024 - paracetamol (oral)", "rationale": "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." ], "peds_mgkg_low": 15.0, "peds_mgkg_high": 15.0, "peds_max_mg": 500.0, "peds_basis": "dose", "peds_unit": "mg", "peds_note": "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.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": [ { "weight_kg": 10, "low_mg": 150, "high_mg": 150, "capped": false }, { "weight_kg": 20, "low_mg": 300, "high_mg": 300, "capped": false }, { "weight_kg": 30, "low_mg": 450, "high_mg": 450, "capped": false }, { "weight_kg": 40, "low_mg": 500, "high_mg": 500, "capped": true } ], "brands": [ { "trade_name": "FEBRIMOL 500 MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 3.5, "pack_count": 20, "unit_price": 0.17, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAMOL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MEMPHIS", "price_egp": 8.0, "pack_count": 20, "unit_price": 0.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARACETAMOL-MUP 500MG B.P. 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MUP", "price_egp": 13.0, "pack_count": 20, "unit_price": 0.65, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CETAL 500 MG 20 TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "EIPICO", "price_egp": 24.0, "pack_count": 20, "unit_price": 1.2, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ARKADOLOW 500 MG 30 F.C. TABS.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "UTOPIA", "price_egp": 42.0, "pack_count": 30, "unit_price": 1.4, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "PARAMOL 500MG 20 TAB.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "MISR", "price_egp": 38.0, "pack_count": 20, "unit_price": 1.9, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ADOL 500MG 24 CAPLETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "JULPHAR", "price_egp": 32.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "AUGICETAMIDE 500 MG 20 SACHETS", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "AUG PHARMA", "price_egp": 50.0, "pack_count": null, "unit_price": null, "strength_mg": 500.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "FEBRIMOL ORAL DROPS 20 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHARCO", "price_egp": 4.0, "pack_count": null, "unit_price": null, "strength_mg": null, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null }, { "trade_name": "THERA-LO 3.2G/100ML ORAL SUSP. 100 ML", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "PHAROPHARMA", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 3200.0, "exact_strength": false, "exact_form": false, "discontinued": false, "also_contains": null } ], "condition_id": "snake-bite" } ] }