Management of snake bite

A 32 year old otherwise fit male from regional  New South  Wales presents with acute onset of headache, abdominal pain, confusion and agitation. He has been working in the garden all day on a hot summer day. On examination, he was a bit clammy at the extremities. Temp 38.5 C. The rest of the examination was unremarkable.

His initial bloods:

Hb

110 g/L

(130-150)

WCC

14.0 X 109/L

(4.0-11.0)

Platelets

220

(150-300)

INR

10

(0.8-1.2)

APTT

>120 sec

(34-38)

Fibrinogen

<1.0 g/L

(1.5-4.0)

Na

144 mmol/L

(135-145)

K

5.1 mmol/L

(3.5-5.0)

Creatinine

180  μmol/L

(40- 110)

Urea

20 mmol/L

(4.0-6.0)

Creatinine Kinase

255  U/L

(<50)

Lipase

436  U/L

(<200)

ALT

80     U/L

(<40)

AST

92    U/L

(<40)

What is the differential diagnosis?

Disclaimer: the viva stem above is the original CICM stem, acquired from their publicly available past papers. However, because the college do not make the rest of the viva text or marking criteria available, the rest has been confabulated. It sounds like a plausible viva and it can be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.