Monitoring Parameters in Snake Bite Patients

Initial Assessment and Management

Emergency services should be activated immediately for any person bitten by a venomous or possibly venomous snake 1
The bitten extremity should be rested and immobilized, and rings or other constricting objects should be removed 1
Harmful practices to avoid include application of ice, use of suction, electric shock, tourniquets, or pressure immobilization bandaging 1

Blood chemistry and complete blood count are essential for evaluating snake bite patients 2
Coagulation studies including prothrombin time (PT/INR), activated partial thromboplastin time (APTT), fibrinogen levels and platelet count should be monitored 3, 4
Hemoglobin and hematocrit should be measured serially to detect blood loss, though initial values may be normal despite significant bleeding 4
Blood lactate and/or base deficit measurements are recommended to estimate and monitor the extent of tissue hypoperfusion and shock 4, 5, 6

The American Heart Association does not recommend LDH monitoring for snake bite patients 1
The definitive treatment for venomous snake bite is antivenom, not guided by LDH levels 1
Focus monitoring on parameters that directly impact clinical decision-making, such as coagulation studies that may indicate need for blood products or antivenom 3
Initial normal laboratory values do not exclude severe envenomation; serial monitoring is essential 4