Anti Snake Venin (ASV) should be given in all these situations with further lab investigations in a child presenting at 4 am except :

Ans: B (Local swelling with fang marks) Ref: The Pediatric Management of Snakebite: The National Protocol, Indian Pediatrics; 43: 173-6 and Snake Site: Indian Guidelines and Protocol. The Association of Physicians of India Chapter 24 Pg 423 and Clinical Profile of Snake Bite in Children in Rural India. Iran J Pediatr, 2013 Dec; 23(6): 632-636. and Achar Textbook of Pediatrics, 4th edition, Pg: 127Explanation:"Among the neuroparalytic bites 60% patients presented with abdominal pain which was the main presenting complaint."Ref: Clinical Profile of Snake Bite in Children in Rural IndiaAnti-Snake VenomAnti-snake venom (ASV) is the mainstay of treatment.in India, polyvalent ASV, i.e. effective against all the four common species:o Russell's vipero Common Cobrao Common Kraito Saw-scaled ViperIndications for ASV administrationEvidence of systemic envenomationProlonged 20 min whole blood clotting time { >20 WBCT).Signs of spontaneous bleeding.Thrombocytopenia (Platelets < 1 lakh/cumm.Neurological symptomso Ptosiso Opthalmoplegiao Respiratory paralysiso Bulbar paralysiso Cardiac signsRenal problemso Oliguriao UremiaHemoglobinuriaMyoglobinuriaSevere Local SymptomsSwelling rapidly crossing joint.Swelling involving half of bitten limb.Swelling increasing rapidly after removal of tourniquet.Development of Enlarged tender regional lymph node.Features of Krait bite:Unique clinical presentation.Movements are mainly nocturnal.Abdominal pain - Most common initial symptom.Often No Pain.No fang mark.No local swelling.Neurological Symptomso Progressive paralysiso Ptosiso Respiratory muscle failure.Note:ASV should NOT be used without evidence of systemic envenomation or severe local swelling.Purely local swelling is Not an Indication for administering ASV.