title: Big snake, small snake: which wound is worse when bitten?
abstract: Snakebites in children and teenagers are relatively uncommon in the metropolitan city of Hong Kong. They are rarely fatal but may cause significant morbidity and fear. We report two cases of snakebites to illustrate that the spectrum of morbidity is independent of the size of the snakes. A 7-year-old boy was bitten in successions by a green snake. Envenomation occurred at the second bite site. He developed local and systemic signs that were promptly relieved with anti-venom therapy at the intensive care unit. An 18-year-old girl was bitten by a large python but only sustained minor local soft tissue injuries. This report serves to alert the public that snake may bite in successions and envenomation may occur with the subsequent bite.
  
  
  CONCLUSIONS
  A small snake may be venomous and a large snake may not be. Avoidable risk factors associated with snakebites (such as avoiding areas known to harbour snakes in the evening in summer and autumn and wearing protective footwear) are highlighted.
authors.affiliation: Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong. ehon@cuhk.edu.hk
authors.forename: Kam-Lun Ellis
authors.initials: KL
authors.lastname: Hon
authors.forename: Ka-Wah Tony
authors.initials: KW
authors.lastname: Lee
authors.forename: Kam-Lau
authors.initials: KL
authors.lastname: Cheung
authors.forename: Pak-Cheung
authors.initials: PC
authors.lastname: Ng
mesh_terms: D000293:Adolescent; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D017821:Boidae; D002648:Child; D005260:Female; D006723:Hong Kong; D006801:Humans; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D012909:Snake Bites / Q000150:complications / Q000473:pathology* / Q000628:therapy; D017841:Trimeresurus; D014757:Viper Venoms / Q000633:toxicity*
chemical_list: D000997:Antivenins; D014757:Viper Venoms