There are a number of ways in which a snake bitten patient may present without snakebite being an obvious diagnosis. In small children, no history of a bite may be given. The child may run inside crying, collapse and possibly have a grand mal convulsion. Unless bite marks are obvious and looked for, the parents may not suspect snakebite and the child may be presented to the doctor as a case of convulsions. Again, in children, if development of envenoming is less precipitate as in the previous example, but again with no history of a bite, the child may be presented to the doctor as becoming progressively unwell, lethargic, with vomiting, mild fever, and possibly apparent neck stiffness and fixed dilated pupils.
If checked, the urine may be dark and showing "haematuria", with abdominal pain. Careful examination in such cases may show progressive paralysis, notably ptosis. The "haematuria" usually is myoglobinuria. The neck stiffness is due to myolysis and the fixed dilated pupils due to the effect of neurotoxins. Even adults may be unaware of being bitten by a snake, such as when walking through long grass, and may present later with headache, nausea and vomiting, or worse still, collapse and be presented unconscious, again, with no history of a bite.
An unnoticed bite might also cause
presenting a day or more after the bite. These are but a few of the
many cryptic presentations for snakebite. Also remember that snakes
can, and do, enter houses and unnoticed snakebites can occur inside
the patient's house!