- Feature Paper
- Article
Sea snake bites are uncommon but may cause severe myotoxic and neurotoxic envenoming. Contemporary clinical data from Thailand remain limited. Using a 15-year retrospective dataset from the Ramathibodi Poison Center, we described the clinical characteristics, treatment, and outcomes of sea snake bites reported between January 2011 and June 2026. Cases were classified as definite when the causative snake was identified from a specimen, photograph, or video, and as possible when identification was based on the patient’s or a witness’s account. Eight patients were included, with a median age of 42 years (range 6–65 years); seven were male, and seven were fishermen. Four cases were classified as definite and four as possible. Five bites occurred while handling fishing nets. Local manifestations were generally mild, with swelling absent in seven patients. Three patients developed rhabdomyolysis with myoglobinuria, with the highest recorded serum creatine kinase concentrations ranging from 39,189 to 239,287 U/L. Two patients developed severe neurotoxic envenoming characterised by ptosis and generalised limb weakness requiring invasive mechanical ventilation. Thai Neuro Polyvalent Antivenom was administered to one patient; however, its clinical effectiveness cannot be determined from this study. In another patient, ophthalmoplegia was first documented on day 6, with intermittent visual symptoms persisting to day 18. Despite marked rhabdomyolysis, no patient developed acute kidney injury. All patients survived. Sea snake bites in Thailand showed a broad clinical spectrum, ranging from mild local effects to severe myotoxic and neurotoxic envenoming. These findings highlight that minimal local manifestations do not exclude severe systemic toxicity and support close neurological assessment and serial monitoring for muscle injury following suspected sea snake bites.
12 November 2026










![Divergence in outcomes between differences (or lack thereof) in predialysis serum beta-2-microglobulin (top panels) and differences in mortality (bottom panels) as reported in two randomized trials: the CONTRAST Study (Grooteman et al. [1]) and the ESHOL study (Maduell et al. [2]). Data truncated to the first 3 years of follow-up. ESHOL study baseline and follow-up predialysis beta-2-microglobulin data are taken from the ESHOL published supplementary data file. Left panels and bottom right panel reproduced with permission from Grooteman MP et al., J. Am. Soc. Nephrol. 2012, 23, 1087–1096, and Maduell F et al., J. Am. Soc. Nephrol. 2013, 24, 487–497, respectively.](https://mdpi-res.com/toxins/toxins-18-00365/article_deploy/html/images/toxins-18-00365-ag-550.jpg)