Antivenom treatment is recommended if patient with proven or suspected snake bite develops one or more of the following signs:

Systemic envenoming

1. Haemostatic abnormalities: Spontaneous systemic bleeding (clinical),coagulopathy (20WBCT or other laboratory tests such as prothrombin time) or thrombocytopenia (<100 x 109/litre or 100 000/cu mm) (laboratory).
2. Neurotoxic signs: ptosis, external ophthalmoplegia, paralysis etc (clinical).
3. Cardiovascular abnormalities: hypotension, shock, cardiac arrhythmia (clinical), abnormal ECG
4. Acute kidney injury (renal failure): oliguria/anuria (clinical), rising blood creatinine/ urea (laboratory).
5. Haemoglobin-/myoglobin-uria: dark brown urine (clinical), urine dipsticks, other evidence of intravascular haemolysis or generalised rhabdomyolysis (muscle aches and pains, hyperkalaemia) (clinical, laboratory).
6. Supporting laboratory evidence of systemic envenoming.

Local envenoming

1. Local swelling involving more than half of the bitten limb (in the absence of a tourniquet) within 48 hours of the bite. Swelling after bites on the digits (toes and especially fingers).
2. Rapid extension of swelling (for example, beyond the wrist or ankle within a few hours of bite on the hands or feet).
3. Development of an enlarged tender lymph node draining the bitten limb with other clinical signs of envenomation.