Snakebite and Envenomation Management in Malaysia

  • Ahmad Khaldun Ismail
Reference work entry
Part of the Toxinology book series (TOXI, volume 2)


Malaysia is a tropical country and snakes are an essential component of its many ecosystems. A number of medically significant venomous land and marine species have been recorded from Malaysia. Humans are exposed to bites and envenoming from these snakes during their engagement in various activities that bring them into the animal’s natural habitat. Snakebite is an important medical emergency and one of the common causes of hospital admission. There is a clear association between the knowledge and confidence level of healthcare providers managing snakebite with the quality of patient care, the provision of appropriate clinical management, the selection of appropriate antivenom, and the outcome of such treatment. The clinical management of snake bites and envenoming may still be suboptimal due to neglect of this issue and negligence at various levels of medical care. The true scale of mortality and morbidity from snakebite remains uncertain as a result of inadequate documentation. To overcome these deficiencies, snake bite envenoming must be recognized as an important notifiable disease. Awareness programs for the public and specially tailored educational programs for healthcare providers should be encouraged and supported. An appropriate clinical management guideline should be established and the inappropriate ones removed. The establishment of an easily accessible qualified clinical expert assistance in managing snakebites and envenomation is also necessary.


Fresh Freeze Plasma Snake Species Snake Bite Coral Snake King Cobra 
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  1. Aiken SP, McArdle JJ, Sellin LC, Schmidt JJ, Weinstein SA. Pre- and post-synaptic effects of a peptide toxin from Trimeresurus wagleri at the rat neuromuscular junction. Pharmacology. 1991;33:186.Google Scholar
  2. Alirol E, Sharma SK, Bawaskar HS, Kuch U, Chappuis F. Snake bite in South Asia: a review. PLoS Negl Trop Dis. 2010;4(1):e603.PubMedCentralPubMedCrossRefGoogle Scholar
  3. American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, European Association of Poison Control Centers and Clinical Toxicologists, International Society on Toxinology, Asia Pacific Association of Medical Toxicology. Pressure immobilization after North American Crotalinae snake envenomation. Clin Toxicol. 2011;49:881–2.CrossRefGoogle Scholar
  4. Ariaratnam CA, Sheriff MH, Arambepola C, Theakston RD, Warrell DA. Syndromic approach to treatment of snake bite in Sri Lanka based on results of a prospective national hospital-based survey of patients envenomed by identified snakes. Am J Trop Med Hyg. 2009;81(4):725–31.PubMedCrossRefGoogle Scholar
  5. Barlow A, Pook CE, Harrison RA, Wüster W. Coevolution of diet and prey-specific venom activity supports the role of selection in snake venom evolution. Proc Biol Sci. 2009;276(1666):2443–9.PubMedCentralPubMedCrossRefGoogle Scholar
  6. Bawaskar HS, Bawaskar PH, Punde DP, Inamdar MK, Dongare RB, Bhoite RR. Profile of snakebite envenoming in rural Maharashtra, India. Trans R Soc Trop Med Hyg. 2002;96(1):79–84.PubMedCrossRefGoogle Scholar
  7. Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Health Organ. 1998;76:515–24.PubMedCentralPubMedGoogle Scholar
  8. Chippaux JP. The toxicology of the venoms. In: Snake venoms and envenomations. Malabar: Krieger Publishing Company; 2006.Google Scholar
  9. Corneille MG, Larson S, Stewart RM, et al. A large single-center experience with treatment of patients with crotalid envenomations: outcomes with and evolution of antivenin therapy. Am J Surg. 2006;192(6):848–52.PubMedCrossRefGoogle Scholar
  10. Dart RC, Seifert SA, Boyer LV, et al. A randomized multicenter trial of crotalinae polyvalent immune Fab (ovine) antivenom for the treatment for crotaline snakebite in the United States. Arch Intern Med. 2001;161(16):2030–6.PubMedCrossRefGoogle Scholar
  11. Das I. A field guide to the reptiles of South-East Asia. London: New Holland; 2010.Google Scholar
  12. Das I. A naturalist’s guide to the snakes of South-East Asia. Oxford: John Beaufoy Publishing; 2012.Google Scholar
  13. Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Engl J Med. 2002;347(5):347–56.PubMedCrossRefGoogle Scholar
  14. Gutiérrez JM, Theakston RD, Warrell DA. Confronting the neglected problem of snake bite envenoming: the need for a global partnership. PLoS Med. 2006;3:e150.PubMedCentralPubMedCrossRefGoogle Scholar
  15. Gutierrez JM, Williams D, Fan HW, Warrell DA. Snakebite envenoming from a global perspective: towards an integrated approach. Toxicon. 2010;56:1223–35.PubMedCrossRefGoogle Scholar
  16. Iddon D, Theakston RD. Biological properties of the venom of the red-necked keel-back snake (Rhabdophis subminiatus). Ann Trop Med Parasitol. 1986;80(3):339–44.PubMedGoogle Scholar
  17. Ismail AK. Snakebite management guide for healthcare providers in Malaysia. Advanced workshop on Marine animal & Snake Envenomation Management (AMSEM) TM; 2011 [updated 2013 June; cited 2013 September 1]. Available at
  18. Ismail AK, Weinstein SA, Auliya M, Apparaeo P. Ventricular bigeminy following a cobra envenomation. Clin Toxicol. 2012;50(6):518–21.CrossRefGoogle Scholar
  19. Ismail AK, Das I, Weinstein S. Image gallery of land snakes of medical significance in Malaysia. First Edition [Internet]; 2013 [updated 2013 July; cited 2013 September 1]. Available from:
  20. Kasturiratne A, Wickremasinghe AR, de Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, Savioli L, Lalloo DG, de Silva HJ. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med. 2008;5:e218.PubMedCentralPubMedCrossRefGoogle Scholar
  21. Lam KK, Crow P, Ng KH, Shek KC, Fung HT, Ades G, Grioni A, Tan KS, Yip KT, Lung DC, Que TL, Lam TS, Simpson ID, Tsui KL, Kam CW. A cross-sectional survey of snake oral bacterial flora from Hong Kong, SAR, China. Emerg Med J. 2011;28(2):107–14.PubMedCrossRefGoogle Scholar
  22. Lavonas EJ, Gerardo CJ, O’Malley G, et al. Initial experience with Crotalidae polyvalent immune Fab (ovine) antivenom in the treatment of copperhead snakebite. Ann Emerg Med. 2004;43(2):200–6.PubMedCrossRefGoogle Scholar
  23. Leong PK, Sim SM, Fung SY, Khomvilai S, Visith S, Tan NH. Cross neutralization of Afro-Asian Cobra and Asian Krait venoms by a Thai polyvalent snake antivenom (neuro polyvalent snake antivenom). PLoS Negl Trop Dis. 2012;6(6):e1672.PubMedCentralPubMedCrossRefGoogle Scholar
  24. Lim BL, Abu Bakar I. Bites and stings by venomous animals with special reference to snakebites in West Malaysia. Med J Malaya. 1970;25:128–41.PubMedGoogle Scholar
  25. Mackessy SP. Handbook of reptile venoms and toxins. Boca Raton: CRC Press, Taylor and Francis Group; 2009.CrossRefGoogle Scholar
  26. McArdle JJ, Lentz TL, Witzemann V, Schwarz H, Weinstein SA, Schmidt JJ. Waglerin I selectively blocks the epsilon form of the muscle nicotinic acetylcholine receptor. J Pharm Exp Therap. 1999;289:543–50.Google Scholar
  27. Mebs D. Venomous and poisonous animals. Boca Raton: CRC Press; 2002. 360.Google Scholar
  28. Minton SA. Venom diseases. Springfiled: Thomas Publishing; 1974.Google Scholar
  29. Minton SA, Minton MR. Venomous reptiles. New York: Scribners; 1980. 308.Google Scholar
  30. Norris RL, Ngo J, Nolan K, Hooker G. Physicians and lay people are unable to apply pressure immobilization properly in a simulated snakebite scenario. Wilderness Environ Med. 2005;16:16–21.PubMedCrossRefGoogle Scholar
  31. Pickwell GV. A review of contemporary sea snake toxinology: chemistry, pharmacology, immunology and clinic-pathological aspects. In: Gopalakrishnakone P, editor. Sea snake toxinology. Singapore: Singapore University Press, National University of Singapore; 1994. p. 93–166.Google Scholar
  32. Reid HA. Myoglobinuria and sea snakebite poisoning. Brit Med J. 1956a;2:73–8.PubMedCentralPubMedCrossRefGoogle Scholar
  33. Reid HA. Sea snakes bite research. Trans R Soc Trop Med Hyg. 1956b;50(6):517–38.PubMedCrossRefGoogle Scholar
  34. Reid HA. Diagnosis, prognosis and treatment of sea snake bite. Lancet. 1961;2:399–402.PubMedCrossRefGoogle Scholar
  35. Reid HA. Antivenom in sea snake bite poisoning. Lancet. 1975a;1:622–3.PubMedCrossRefGoogle Scholar
  36. Reid HA. Epidemiology of sea snake bites. J Trop Med Hyg. 1975b;78(5):106–13.PubMedGoogle Scholar
  37. Russell FE. Snake venom poisoning. Philadelphia: Lippincott; 1980. p. 562.Google Scholar
  38. Schmidt JJ, Weinstein SA. Structure-function studies of waglerin I, a lethal peptide from venom of Wagler’s pit viper, Trimeresurus wagleri. Toxicon. 1995;33:1043–9.PubMedCrossRefGoogle Scholar
  39. Seifert S, White J, Currie BJ. Pressure bandaging for North American snake bite? No! J Med Toxicol. 2011;7:324–6.PubMedCentralPubMedCrossRefGoogle Scholar
  40. Simpson ID, Tanwar PD, Andrade C, Kochar DK, Norris RL. The Ebbinghaus retention curve: training does not increase the ability to apply pressure immobilization in simulated snake bite – implications of snake bite first aid in the developing world. Trans R Soc Trop Med Hyg. 2008;102(5):451–9.PubMedCrossRefGoogle Scholar
  41. Sotelo N. Review of treatment and complications in 79 children with rattlesnake bite. Clin Pediatr. 2008;47(5):483–9.CrossRefGoogle Scholar
  42. Stephen A, Lim BL. A study of snake-bites in Peninsular Malaysia with special reference to Perlis & Kedah from 1979–1983. Trop Biomed. 1998;5:65–70.Google Scholar
  43. Tanen DA, Danish DC, Grice GA, Riffenburgh RH, Clark RF. Fasciotomy worsens the amount of myonecrosis in a porcine model of crotaline envenomation. Ann Emerg Med. 2004;44:99–104.PubMedCrossRefGoogle Scholar
  44. Warrell DA. Unscrupulous marketing of snake bite antivenoms in Africa and Papua New Guinea: choosing the right product – ‘What’s in a name? Trans R Soc Trop Med Hyg. 2008;102:397–9.PubMedCrossRefGoogle Scholar
  45. Warrell DA. Snake bite. Lancet. 2010;375(9708):77–88.PubMedCrossRefGoogle Scholar
  46. Weinstein SA, Schmidt JJ, Bernheimer AW, Smith LA. Characterization and amino acid sequences of two lethal peptides from venom of Wagler’s pit viper (Trimeresurus wagleri). Toxicon. 1991;29:227–36.PubMedCrossRefGoogle Scholar
  47. Weinstein S, Dart R, Staples A, White J. Envenomations: an overview of clinical toxinology for the primary care physician. Am Fam Physician. 2009;80(8):793–802.PubMedGoogle Scholar
  48. WHO Expert Committee. Guidelines for the production, control and regulation of snake antivenom immunoglobulins. WHO; 2010. Available at
  49. World Health Organization. Guidelines for the clinical management of snake bite in the South East Asia region. New Delhi WHO South East Asia Regional Office; 2010. Available at
  50. Wuster W. Taxonomic changes and toxinology: systemic revisions of the Asiatic Cobras (Naja Naja species complex). Toxicon. 1996;34(4):399–406.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2015

Authors and Affiliations

  1. 1.Department of Emergency Medicine, Faculty of MedicineUniversiti Kebangsaan Malaysia Medical CentreCheras, Kuala LumpurMalaysia

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