Not all of these will necessarily occur, even with severe envenomation. The above symptoms can manifest within 5 hours after envenomation. Edema usually begins within the first few minutes after the bite. Though pain and edema are the major local manifestations, hemorrhage around the bite site is common. Tissue necrosis is seen less frequently.
Extensive necrosis can occur.
This results in a DIC type coagulopathy with an increase in PTT and bleeding times. Fibrinogen levels and sedimentation rates are generally decreased. However, platelets are within normal limits. Fang marks may be present as one or more well defined punctures, as a series of small lacerations, or scratches, or there may not be any noticeable or obvious markings where the bite occurred. The presence of fang marks does not always imply that envenomation occurred.