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Snakes: Differential Diagnosis

In most cases, patients are aware that they have been bitten by a snake. However, in the rare cases where the bite is not immediately known, the differential diagnosis can be quite diverse. The initial symptoms of tissue edema and erythema can initially mimic urticaria and angioedema. However, when the ecchymosis, blistering, and signs of tissue necrosis become evident, disseminated intravascular coagulopathy, sepsis, and idiopathic thrombocytopenia can also be in the differential diagnosis.

In the case of elapid envenomations, it is important to recognize that the patient's neuromuscular weakness is due to a coral snake bite rather than other etiologies, such as paralytic shellfish poisoning, tetrodotoxin poisoning, Guillain-Barré syndrome, botulism, myasthenia gravis, tick paralysis, periodic paralysis, and other forms of neuromuscular weakness. A detailed history, careful physical exam, and a working knowledge of the clinical presentation of such snakebites are of the utmost importance.3,28

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Last Modified: 08/17/2017
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