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Rongde Lai, Shijiao Yan, Shijun Wang, Shuqing Yang, Zhangren Yan, Pin Lan, Yonggao Wang, Qi Li, Jinlong Wang, Wei Wang, Yuefeng Ma, Zijing Liang, Jianfeng Zhang, Ning Zhou, Xiaotong Han, Xinchao Zhang, Mao Zhang, Xiaodong Zhao, Guoqiang Zhang, Huadong Zhu, Xuezhong Yu, Chuanzhu Lyu
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| Severity | Clinical manifestations | | No poisoning | Only teeth marks (“dry bite”) without any other symptoms and signs | | Light | Only local symptoms around the wound, such as pain, bleeding from the wound, skin bruising, non-progressive limb swelling not exceeding the elbow or knee, and no progress in 12 h after the bite; local sensory abnormalities, numbness, neuropathic pain, muscle spasm, and fasciculation | | Moderate | Progressive swelling, purpura, or ecchymosis away from the wound, not exceeding half of the limb; non-fatal systemic symptoms or signs, such as nausea, vomiting, hematemesis/melena; mild perioral numbness, mild fatigue, respiratory muscle weakness resulting in dyspnea or other respiratory discomfort, language barriers, diplopia, hearing or taste abnormalities, and difficulty swallowing; slight changes in laboratory results (<2 times the upper limit of normal), mild abnormalities in coagulation function but no systemic bleeding | | Severe | Local symptoms such as widespread swelling, erythema, or ecchymosis rapidly progressing beyond more than half of the body, or bites on the head, neck, or trunk; obvious symptoms and signs such as fatigue or progressive muscle weakness, blurred vision, ptosis, altered consciousness, tachycardia, shortness of breath or distress, or the need for mechanical ventilation support, hemodynamic instability (such as hypotension or shock), suspected or confirmed intracranial or abdominal bleeding; laboratory results showing significant abnormalities, such as severe coagulopathy with bleeding in areas other than the wound, thrombocytopenia, significant abnormalities in muscle enzymes (≥2 times the upper limit of normal) |
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