Treatment of Common Sea Snake Bite
Apply pressure immobilization bandaging immediately to the entire bitten limb (40-70 mm Hg upper extremity, 55-70 mm Hg lower extremity) and activate emergency services for urgent antivenom administration—this is fundamentally different from North American pit viper management. 1
Immediate Field Management
Critical first actions:
Apply pressure immobilization bandaging around the entire length of the bitten extremity to restrict lymphatic flow and slow venom dissemination without compromising arterial circulation 1
Activate emergency medical services immediately—definitive treatment requires antivenom only available in hospital settings 1, 3
Completely immobilize the bitten extremity and keep it below heart level to minimize venom absorption through the lymphatic system 1, 3
Remove all rings, watches, and constricting jewelry immediately before swelling develops, as edema can cause ischemic injury to digits 2, 1, 3
Minimize patient exertion during transport—walking or physical activity increases systemic venom absorption 1, 3
Dangerous Interventions to Avoid
Do NOT perform the following—they are ineffective or harmful:
No ice or cold therapy—ineffective for venom removal and can cause tissue injury 2, 1, 3
No suction devices, incision, or mouth suction—these methods are ineffective at removing venom and may cause additional tissue damage 2, 1, 3
No tourniquets—systematic reviews show they worsen local tissue injury without preventing systemic envenomation 2, 1, 3
No electric shock therapy—both ineffective and potentially harmful 2, 1, 3
Critical Clinical Distinctions
Sea snakes present a diagnostic pitfall that can be fatal:
The absence of pain or swelling does NOT rule out serious envenomation—this is the most dangerous misconception, as sea snakes cause life-threatening systemic neurotoxicity and myotoxicity despite minimal local findings 1, 4
Sea snake venoms contain presynaptic and postsynaptic neurotoxins with extremely low LD50 values, making them highly toxic 4
Monitor continuously for signs of neurotoxicity: muscle weakness, ptosis, difficulty swallowing, respiratory distress, altered mental status, or myotoxicity 1, 4
The clinical syndrome is largely neurotoxic and myotoxic, with rare hepatotoxicity and nephrotoxicity 4
Hospital-Based Definitive Treatment
Antivenom administration is lifesaving:
Hospitalize for a minimum of 48 hours with continuous monitoring, as neurotoxicity onset can be delayed and progression is rapid once symptoms begin 1
Antivenom is the mainstay of treatment and is most effective when administered early 4
Hemodialysis may be useful when antivenom is not available 4
Artificial ventilation may be required for respiratory paralysis 5
Key Algorithmic Differences from North American Snakes
The 2024 American Heart Association guidelines explicitly state that snakes in other parts of the world (including sea snakes) have different venom effects requiring different first aid measures than North American species 2, 1:
North American pit vipers (>95% of US bites): Cytotoxic venom causing tissue injury—pressure immobilization is NOT recommended and may worsen local tissue damage 2, 3
Sea snakes: Neurotoxic venom with minimal local injury—pressure immobilization IS recommended and is the most effective pre-hospital intervention 1, 4
Critical Pitfalls to Avoid
Assuming no envenomation based on lack of local symptoms is dangerous—sea snakes cause minimal local findings despite life-threatening systemic toxicity 1
Delaying transport to attempt ineffective field interventions wastes critical time—time to antivenom is the most important prognostic factor 1
Failing to apply pressure immobilization for sea snakes eliminates the most effective pre-hospital intervention for slowing venom spread 1
Applying North American snakebite protocols to sea snake bites can be fatal—the management is fundamentally different 2, 1