• Epidemiology: Worldwide, 1.2–5.5 million snakebites are sustained each year, with 421,000–1,841,000 envenomations and 20,000–94,000 deaths.
    • Bite rates are highest in temperate and tropical climates where populations subsist by manual agriculture and fishing.
    • Differentiation of venomous from nonvenomous snake species can be difficult; color pattern is notoriously misleading.
  • Clinical features: Snake venoms are complex mixtures of enzymes and other substances that promote vascular leaking, cause tissue necrosis, affect the coagulation cascade, and impair organ function.
    • Specific presentations differ somewhat with the particular snake species.
    • Systemic symptoms may include hypotension, pulmonary edema, hemorrhage, altered mental status, or paralysis (including muscles of respiration).
  • Prognosis: The overall mortality rate for venomous snakebite is <1% among U.S. victims who receive antivenom; the incidence of permanent functional loss in a bitten extremity is substantial.

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