Trusted medical expertise in seconds.

Access 1,000+ clinical and preclinical articles. Find answers fast with the high-
powered search feature and clinical tools.

TRY FREE FOR 5 DAYS

Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer.

Animal bites and stings Last updated: January 14, 2022

Summary
Expand all sections REGISTER LOG IN

A wide variety of animals, both wild and domestic, will bite or sting to ward off enemies or
kill prey, posing a common cause for visits to the emergency department. Arthropod, reptile,
fish, jellyfish, and mollusk stings and bites generally cause little mechanical trauma to
humans, but they can cause potentially severe local and/or systemic damage if they deliver
venom. Clinically significant venomous animals include various species of spiders (e.g., black
widow and recluse spiders), scorpions (e.g., Arizona bark scorpion), hymenoptera (esp. bees
and wasps), snakes (e.g., rattlesnakes), fish (e.g., scorpionfish, stonefish), mollusks (e.g., blue-
ringed octopus, cone snails), and jellyfish (box jellyfish). While venomous mammals exist (e.g.,
shrews, slow lorises, platypuses), attacks on humans are rare. Mammal bites are instead
clinically relevant for the mechanical trauma they cause (esp. with larger mammals, such as
dogs) and the risk of infection (e.g., rabies, rat-bite fever). Diagnosis involves wound
assessment, ruling out hypersensitivity reactions, and identifying the animal responsible to
determine the risk of infection and/or envenomation. Symptoms of envenomation depend
on the species of animal and may involve local pain, swelling, and paresthesia;
hypersensitivity reactions up to anaphylaxis; nonspecific symptoms (e.g., nausea and
vomiting); and, in severe cases, neurotoxicity, autonomic dysfunction, and shock. Treatment
depends on the severity of the bite or sting and the animal responsible, potentially involving
trauma care up to surgery, hypersensitivity management up to epinephrine, care with
antibiotics, and the administration of antivenom.
For the general management of animal bites, see ”Bite wounds.” and “Rabies risk
assessment.”

Dog bites

Domestic cat bites

Rodent bites

Snakebites

Epidemiology [6]
∼ 5000 venomous snakebites per year in the US
Crotaline snakes (pit vipers, e.g., rattlesnakes, copperheads, cottonmouths) are
 ( , e.g., rattlesnakes, copperheads, cottonmouths) are
responsible for the majority of snakebites in the US.
Clinical features
“Dry bites” (bites without envenomation): minor local symptoms
Envenomation leads to varying degrees of local and systemic symptoms that depend on
the amount and toxicity of the venom (see table below).

Common snakebites [7][8]

Rattlesnakes Coral snakes Black mamba

snake

Distinguishing features Subtle earth-tone Alternating red, Long, slender,

colored skin with yellow, and black cylindrical snake
rattle tail, triangular color bands with a coffin-
head, and vertical shaped head
pupils

Distribution All US states except Southern US and Sub-Saharan

Maine, Hawaii, and northern Mexico Africa

Alaska

Venom Cytohemoneurotoxic Neurotoxin Dendrotoxin:

potassium
Increases Causes competitive
channel
permeability of the inhibition of
blockage and
cell membrane presynaptic and
increased
Fibrinolytic and postsynaptic
release of ACh
muscarinic AChR
protein C-activation the
effect neuromuscular
junction

Clinical Local Severely painful bite Bite painless or Multiple bite

mildly painful sites
features of Swelling,
ecchymoses, Swelling and No local swelling
envenomation
erythema paresthesia and minimal
tingling
Tissue necrosis
sensation

Systemic Nausea, vomiting Nausea, vomiting, Nonspecific: e.g.,

abdominal pain metallic taste
Coagulopathy: can
nausea,
lead to DIC and Neurotoxicity
vomiting,
bleeding Descending
abdominal pain
Thrombocytopenia paralysis: e.g.,
bulbar paralysis, Neurotoxicity:
Hemodynamic ophthalmoplegia e.g., ptosis,
instability: e.g., , dysphagia, bulbar palsy,
tachycardia, dysarthria paresthesia, and
hypotension, dysarthria
distributive shock Respiratory
depression Autonomic
Neurotoxicity: e.g., symptoms: e.g.,
Autonomic
paresthesias, hypersalivation
symptoms: e.g.,
altered mental status diarrhea,
hypersalivation,
, seizures sweating, and
miosis
miosis
Can lead to
hyperexcitability,
convulsion, loss
of
consciousness
and respiratory
paralysis

Diagnostics: usually based on history (description of possible identifying features of the

snake) and clinical features
 Grading scale for snakebite severity [9][10]

Degree of Clinical features

severity

Asymptomatic Asymptomatic
Punctures or abrasions
Minimal edema and/or erythema

Mild Painful bite

Localized erythema and edema

Moderate Painful bite

Tenderness, erythema, edema beyond the bite area
Systemic features (e.g., tachycardia, tachypnea, nausea, vomiting)
Signs of coagulopathy (e.g., abnormal coagulation parameters)

Severe Severely painful bite

Swelling of the entire affected extremity
Severe systemic features (e.g., hypotension, paresthesia)

Signs of coagulopathy (e.g., hemorrhage)

Life- Abnormal systemic features (e.g., seizures, altered mental status,

respiratory failure, shock)
threatening
Severe coagulopathy (e.g., DIC)

Management [7]

Antivenom administration
Can slow or halt the progression of toxicity and is most effective when administered
within 4–6 hours of the snakebite [9]
Should only be given to patients with clear symptoms of envenomation and in whom
the benefits are likely to exceed the risks of adverse reaction to antivenom

For pit viper bites: crotalidae polyvalent immune fab

Adverse effects: hypersensitivity, serum sickness

Pressure immobilization and/or tourniquets are not recommended as part of routine

[11]
management in the US.

Patients must be monitored closely for signs of cardiovascular instability and

respiratory compromise.

Spider bites

Scorpion stings

Jellyfish stings

Hymenoptera stings

Shellfish

References
© 2020 AMBOSS Medical Knowledge Terms and Conditions Privacy Privacy Settings
Legal Notice Get Support & Contact Us

1 free articles remaining

SIGN UP HAVE AN ACCOUNT? LOG IN