Animal Envenomation S008

Current RMA Instruments

Changes from previous Instruments

ICD Coding:

• ICD-10-AM Codes: T63, X20-X27, X29

Brief description

This SOP covers the toxic or hypersensitivity effects resulting from contact with animal venom. It covers envenomation caused by bites, stings or other venom delivery mechanism from animals. It does not include reactions caused by plants or by ingesting toxins or allergens (e.g. through eating fish). 

Confirming the diagnosis

Diagnosing animal envenomation involves a clinical presentation that suggests the toxic or hypersensitivity effects of contact with animal venom. This is based on a medical practitioner's assessment of the person's symptoms and examination findings being consistent with envenomation.

Pathology tests or imaging are not required to establish the diagnosis. Identification of the specific animal is helpful when available but is not essential. Assessment and management may involve general practitioners or emergency physicians depending on the severity and nature of the reaction.  

Diagnoses not covered by SOP

• Environmental exposures not involving venom (e.g. marine rash from sea lice) #
• Injuries from animal bites without venom (e.g. dog bites or rodent bites producing infection or trauma only) #
• Illness caused by ingestion of toxins, allergens or parasites (e.g. ciguatera poisoning from reef fish, shellfish toxin ingestion, allergic reactions to seafood or insects when eaten) #
• Fugu/pufferfish poisoning #
• Food allergy, e.g. from eating crustaceans #
• Non-venomous arthropod reactions #
• Plant-related stings, irritant reactions or contact dermatitis (e.g. stinging nettle, spines and saps from plants) #

^# non-SOP condition

Clinical onset

The clinical onset refers to the earliest point at which symptoms or signs consistent with envenomation are first observed by the treating doctor following contact with animal venom. Onset is usually rapid- most often within minutes to hours- presenting with local pain, swelling, itching or other characteristic features, and occasionally early systemic symptoms. 

An exception is paralysis tick envenomation, where symptoms may emerge more gradually and may not become apparent for several days, with onset sometimes occurring up to 12 days after the bite. 

Clinical worsening

When considering clinical worsening, it is important to determine whether any deterioration goes beyond what would be expected from the usual course of envenomation. Worsening in this condition generally relates to a failure to receive timely or appropriate clinical management, resulting in progression of local or systemic effects. 

Assessment by an appropriate medical practitioner is required to determine whether such deterioration represents true clinical worsening rather than the natural evolution of the reaction.