Emergent Care / Stabilization:
Most cases of hognose snake bites are nonemergent. At the initial presentation, check the wound area for the extent of injuries, provide appropriate analgesia, and identify the species of snake involved.

Diagnosis Overview:
Western hognose snakes, Heterodon nasicus, are rear-fanged snakes typically located in rocky, prairie, or sandy habitats in the central United States. Hognose snake bites are uncommon. Most bites occur from snakes in captivity, as these snakes have become popular house pets. The pathophysiology of the reaction following hognose snake bites is not fully understood, but it is thought to be due to a type I hypersensitivity reaction to secretory antigens rather than a direct effect of the venom. Studies looking at the oral secretion of western hognose snakes have found little evidence of toxic substances such as protease activity, thrombin-like, hyaluronidase, or kallikrein-like activity.

Manifestations of hognose snake bites are typically confined to the limb that was bitten, without any systemic findings. Initially, there is edema of the affected limb that may be accompanied by ecchymoses, pain, stiffness, and local lymphadenopathy. Puncture wounds may be evident, and vesicles and bullae may form within a couple of days of the bite. Secondary infection (cellulitis) has been reported, and a case of thrombocytopenia has been documented. Resolution may take weeks and may be accompanied by pruritus.