Treatment of Green Himalayan Snake Bite
The treatment for a green Himalayan snake bite requires immediate administration of appropriate antivenom, with an initial dose of 4-6 vials, followed by additional doses until initial control of envenomation is achieved. 1
Immediate Actions
- Call emergency services immediately
- Rest and immobilize the bitten extremity
- Remove constricting jewelry
- Transport the victim to the nearest emergency medical facility as quickly as possible
DO NOT:
- Apply ice
- Use suction devices
- Apply electric shock
- Use tourniquets or pressure immobilization bandaging for these types of snake bites 1
Hospital Management
Initial Assessment
- Complete blood count, coagulation studies, renal function tests, electrolytes, and cardiac monitoring to assess for:
- Hemolysis
- Anemia
- Coagulopathy
- Acute kidney injury 1
Antivenom Administration
- Grade the severity of envenomation (mild, moderate, severe)
- Administer antivenom intravenously as soon as possible:
- Mild cases: Up to 5 vials may be required
- Moderate cases: 10-15 vials may be required
- Severe cases: 15-20 vials may be required 2
- Monitor for 1 hour after initial dose
- Continue administration until:
- Local injury progression stops
- Systemic symptoms resolve
- Coagulation parameters normalize or trend toward normal 1
Important Precautions
- Perform skin testing before antivenom administration to predict possible anaphylactic reactions
- Have diphenhydramine and epinephrine readily available in case of anaphylaxis 2
- Clean the wound and administer broad-spectrum antibiotics
- Verify tetanus status and administer tetanus toxoid if necessary 2
Supportive Care
- Monitor oxygen saturation and provide supplemental oxygen if hypoxic
- Early intubation and mechanical ventilation at first sign of respiratory compromise
- Respiratory support may be required for several days 1
- Aggressive fluid resuscitation with normal saline (initial rate 1000 ml/h, then tapered by at least 50% after 2 hours)
- Avoid potassium-containing balanced salt fluids due to risk of hyperkalemia 1
Monitoring and Follow-up
- Monitor for recurrent coagulopathy for at least one week following treatment
- Long-term follow-up is essential as up to 41% of patients may show persistent renal involvement
- Risk of progression to chronic kidney disease in approximately 5-20% of cases 1
Special Considerations
- Fasciotomy is only indicated in rare cases involving elevated intracompartment pressures 2
- Consultation with a physician specialist experienced in snake envenomation is highly recommended 3
- Mortality rate can be significantly reduced with prompt medical intervention, particularly early respiratory support and antivenom administration 1
The most critical aspect of treatment is the rapid administration of appropriate antivenom. Delays in antivenom administration can lead to increased morbidity and mortality, with respiratory failure potentially occurring within 12-30 hours after the bite if left untreated 1.