Exotic snake bite: a challenge for the Scandinavian anesthesiologist?

Area of Science:

• Herpetology
• Toxicology
• Clinical Medicine

Background:

• Venomous snakebites are rare in Scandinavia, but exotic snake envenomations occur, particularly in snake handlers.
• This case report details an envenomation by the Broad-Headed snake (Hoplocephalus bungaroides), an Australian elapid.
• The genus Hoplocephalus is typically considered of lesser medical importance due to rarity.

Observation:

• A previously healthy man experienced systemic envenomation after contact with an exotic snake.
• The patient presented with rapid onset of severe coagulopathy, rhabdomyolysis, and cardiotoxicity.
• Notably, the patient did not develop respiratory insufficiency, neurotoxicity, or renal failure.

Findings:

• Envenomation by Hoplocephalus bungaroides resulted in significant coagulopathy within an hour.
• Biochemical markers indicated rhabdomyolysis and cardiotoxicity.
• Treatment involved supportive care (crystalloids, plasma, corticosteroids, antifibrinolytics) and observation in the intensive care unit (ICU).
• Causal treatment with monovalent Tiger snake antivenom was effective in resolving the coagulopathy.

Implications:

• This case highlights the potential severity of envenomation from exotic snakes, even those not typically considered highly dangerous.
• Effective management relies on prompt recognition of symptoms and appropriate antivenom therapy.
• Successful treatment led to the patient's discharge from the ICU within 26 hours, demonstrating good prognosis with timely intervention.