Table 4.

Acute Hospital Treatment

Symptoms	Observation	Laboratories	Hospital Course	Complications
Hematologic	Monitor at least 12 h.	CBC	Patient receives supportive treatment and appropriate amount of antivenom. If secondary sequelae are absent, there is no progression of local symptoms and local erythema/swelling is controlled with no proximal progression, patient can be discharged with follow up laboratory tests	If new symptoms arise (fever, SOB, dizziness, nausea, vomiting), return to hospital for further evaluation and treatment
		CMP
		Coagulation studies
		Liver function tests
Neurologic	Monitor at least 24 h.	CBC	Patient receives supportive treatment and appropriate amount of antivenom. Specific monitoring of neurological functioning is performed. If secondary sequelae are absent, there is no progression of local symptoms and an improvement of neurological symptoms, patient can be discharged with follow-up laboratory tests	If new symptoms arise (visual disturbance (ptosis, and diplopia), dysphagia, diaphoresis, peripheral nerve palsy, diminished reflexes, and in severe cases, respiratory depression and paralysis), return to hospital for further evaluation
		CMP
		Coagulation studies
		Liver function tests
		Respiratory function tests