Abstract
Snake ‘dry bites’ are characterized by the absence of venom being injected into the victim during a snakebite incident. The dry bite mechanism and diagnosis are quite complex, and the lack of envenoming symptoms in these cases may be misinterpreted as a miraculous treatment or as proof that the bite from the perpetrating snake species is rather harmless. The circumstances of dry bites and their clinical diagnosis are not well-explored in the literature, which may lead to ambiguity amongst treating personnel about whether antivenom is indicated or not. Here, the epidemiology and recorded history of dry bites are reviewed, and the clinical knowledge on the dry bite phenomenon is presented and discussed. Finally, this review proposes a diagnostic and therapeutic protocol to assist medical care after snake dry bites, aiming to improve patient outcomes.
Highlights
IntroductionAbout 5.4 million snakebites occur worldwide. These cause up to 2.7 million envenomings, almost 138,000 deaths, and 400,000 cases of sequelae or disability [1,2]
Every year, about 5.4 million snakebites occur worldwide
We present the anatomy of the snake venom apparatus, review the current knowledge on snake dry bites, and discuss the diagnostic and clinical implications of these bites
Summary
About 5.4 million snakebites occur worldwide. These cause up to 2.7 million envenomings, almost 138,000 deaths, and 400,000 cases of sequelae or disability [1,2]. A study conducted over three years at the Toxinology and Toxicology Unit of the General Hospital of the Central Province of Sri Lanka in Peradeniya demonstrated that in over 776 snakebite admissions, 86% of the patients had received a bite in which no venom had been injected [15]. It can, be difficult to determine whether a bite is ‘dry’ or ‘wet’, as a bite from any animal will often cause inflammation and swelling. We present the anatomy of the snake venom apparatus, review the current knowledge on snake dry bites, and discuss the diagnostic and clinical implications of these bites
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