REVIEW Open Access Venomous snake bites: clinical diagnosis and treatment Toru Hifumi 1* , Atsushi Sakai 2 , Yutaka Kondo 3 , Akihiko Yamamoto 4 , Nobuya Morine 5 , Manabu Ato 6 , Keigo Shibayama 4 , Kazuo Umezawa 7 , Nobuaki Kiriu 8 , Hiroshi Kato 8 , Yuichi Koido 8 , Junichi Inoue 9 , Kenya Kawakita 1 and Yasuhiro Kuroda 1 Abstract Snake bites are life-threatening injuries that can require intensive care. The diagnosis and treatment of venomous snake bites is sometimes difficult for clinicians because sufficient information has not been provided in clinical practice. Here we review the literature to present the proper management of bites by mamushi, habu, and yamakagashi snakes, which widely inhabit Japan and other Asian countries. No definite diagnostic markers or kits are available for clinical practice; therefore, definitive diagnosis of snake-venom poisoning requires positive identification of the snake and observation of the clinical manifestations of envenomation. Mamushi (Gloydius blomhoffii) bites cause swelling and pain that spreads gradually from the bite site. The platelet count gradually decreases due to the platelet aggregation activity of the venom and can decrease to <100,000/mm 3 . If the venom gets directly injected into the blood vessel, the platelet count rapidly decreases to <10,000/mm 3 within 1 h after the bite. Habu (Protobothrops flavoviridis) bites result in swelling within 30 min. Severe cases manifest not only local signs but also general symptoms such as vomiting, cyanosis, loss of consciousness, and hypotension. Yamakagashi (Rhabdophis tigrinus) bites induce life-threatening hemorrhagic symptoms and severe disseminated intravascular coagulation with a fibrinolytic phenotype, resulting in hypofibrinogenemia and increased levels of fibrinogen degradation products. Previously recommended first-aid measures such as tourniquets, incision, and suction are strongly discouraged. Once airway, breathing, and circulation have been established, a rapid, detailed history should be obtained. If a snake bite is suspected, hospital admission should be considered for further follow-up. All venomous snake bites can be effectively treated with antivenom. Side effects of antivenom should be prevented by sufficient preparation. Approved antivenoms for mamushi and habu are available. Yamakagashi antivenom is used as an off-label drug in Japan, requiring clinicians to join a clinical research group for its use in clinical practice. Keywords: Mamushi, Habu, Yamakagashi, Antivenom Introduction Throughout the world, snake bites remain life-threatening injuries [1-4], sometimes requiring intensive care [5]. Simi- lar to malaria, dengue hemorrhagic fever, tuberculosis, and parasitic diseases, the risk of snake bite is always present [1]. In 2009, the World Health Organization (WHO) added snake bites to the list of neglected tropical diseases, which includes dengue hemorrhagic fever, cholera, and Japanese encephalitis. The mortality associated with snake bites is much greater than that of other neglected tropical diseases [1]. Moreover, the 2014 dengue fever outbreak in Tokyo, Japan, was promoted by climate change and intensive interaction between people; these factors may thus contrib- ute to outbreaks of other tropical diseases in the future. Venomous snakes of the same genus as mamushi (Gloydius), habu (Protobothrops), and yamakagashi (Rhabdophis) inhabit Japan and other Asian countries [6-8]. The incidence of bites by these venomous snakes is reported as approximately 1,000 cases with 10 deaths annually for mamushi (Gloydius blomhoffii) [9], 100 cases annually for habu (Protobothrops flavoviridis) [10], and 34 cases with 4 deaths over the past 40 years for yamakagashi (Rhabdophis tigrinus) [6]. * Correspondence: hifumitoru@gmail.com 1 Emergency Medical Center, Kagawa University Hospital, 1750-1 Ikenobe, Miki, Kita, Kagawa 761-0793, Japan Full list of author information is available at the end of the article © 2015 Hifumi et al.; licensee BioMed Central. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Hifumi et al. Journal of Intensive Care (2015) 3:16 DOI 10.1186/s40560-015-0081-8