Fatal Sea Snake Envenomation.

A 23-year-old man working on a prawn trawler off the Northern Australian coast was bitten on the right hand by a black-banded sea snake (Laticauda colubrina), resulting in the rapid onset of ptosis, blurred vision, and respiratory difficulties with convulsions, loss of consciousness, and death. Resuscitation was unsuccessful. No antivenom was available because of the remote location. At autopsy, a small puncture wound was identified on the middle interphalangeal joint of the right little finger. No other significant abnormalities were detected. Elevations in creatine kinase (1558 μ/L) and myoglobin (24,800 μg/L) levels were found. Death was caused by respiratory failure after sea snake envenomation. This case demonstrates potential difficulties in establishing the diagnosis of lethal sea snake envenomation, including the inconspicuous nature of the bite marks with no local reaction and the underlying neurotoxic nature of the lethal mechanisms, which leaves very nonspecific pathological findings. Myonecrosis may occur but is variable. Unless reliably witnessed, sea snake envenomation may not be suspected. Failing vision or unexplained paresis in fishermen or individuals who have been in the sea may point to the diagnosis.