# Snake Bite - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: WHO Snakebite envenoming - treatment (Control of Neglected Tropical Diseases, who.int) · MSF Essential Drugs 2024 - paracetamol (oral) - Verified date: 2026-08 ## 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) ## Treatment metadata - Referral & safety-netting (no drug therapy) - Paracetamol — 500 mg — oral.solid ## Complete treatment card ```text SNAKE BITE Sources: WHO Snakebite envenoming - treatment (Control of Neglected Tropical Diseases, who.int) · MSF Essential Drugs 2024 - paracetamol (oral) Review status: REVIEWED 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) (2026-08) 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 Source StatPearls "Evaluation and Treatment of Snake Envenomations" - disease-level clinical article Status 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 Immobilize the bitten limb (splint), keep patient completely still, and arrange immediate emergency transport to a hospital equipped with antivenom - Immediate emergency transfer Peds Immediate emergency pediatric transport 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. Caution 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 [add-on - not a substitute] Adult 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 Peds 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.) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) 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. Caution 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. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)