Black mambas are among the commonly found snakes in Tanzania and are considered highly venomous. They cause local and systemic effects and result in high morbidity and mortality. The diagnosis of black mamba snake bite is confirmed by the identification of the reptile and assessment of the clinical manifestations.
The black mamba (Dendroaspis polylepis), which is one of the most predominant species of snakes in Tanzania, is classified as category 1 for its "highly venomous" activity by the World Health Organization  . Additionally, this animal is among other species that frequently attack humans . The envenomings have a severe morbidity and high mortality rates  . This neglected tropical disease poses a significant public health risk in rural regions due to the prevalent number of snakes, inadequate health care, and the lack of antivenoms in these areas   . All of these factors contribute to poor prognosis.
The clinical presentation may include local and systemic involvement. The site of the snakebite is typically characterized by pain, warmth, bruising, hemorrhagic swelling, and necrosis . Moreover, the snake venom may lead to toxicity of the cardiovascular, nervous, renal, muscular, and hematologic systems . Features include nausea, trouble swallowing, epistaxis, hemoptysis, paresthesia, and syncope. Additionally, patients develop seizures and mental status changes such as delirium and possibly coma .
If tissue necrosis occurs, this may lead to compartment syndrome and subsequent digit amputation  . Furthermore, victims are at risk for long-term disability and disfigurement secondary to tissue necrosis . Overall, snakebites inflict significant impact on the patient's daily quality of life .
The vital signs in acute episodes are likely to show evidence indicative of shock. With regards to the snakebite site, it is marked by pitting edema, possibly fang marks, local hematoma, necrosis, and petechiae. Additionally, systemic findings will reflect the affected organ(s)/system(s).
One of the main components of the workup is the history, which should consist of details about how the attack occurred, timing of the bite, onset of manifestations such as pain, and details about the symptoms. Also important are the type and description of the snake (if known). Stable patients warrant a complete physical exam and a thorough assessment for signs of systemic effects. Acutely ill cases must be stabilized first. Note that the diagnosis is confirmed by identifying the snake and evaluating the resultant envenomation symptoms .
If possible, the clinician should obtain the patient's complete blood count (CBC), electrolyte panel, renal function tests, and coagulation studies including the international normalized ratio (INR) . Further tests consist of an arterial blood gas (ABG), peripheral smear, blood type and cross-match, and a urinalysis.
Findings may include leukocytosis, thrombocytopenia, worsening anemia, azotemia, and hypoalbuminemia . Additionally, the test results may demonstrate low fibrinogen levels and other findings consistent with DIC  . Proteinuria is also a feature .
Individuals with respiratory distress should have a chest X-ray performed. Additionally, a radiograph of the affected body part is needed to assess the possible presence of a fang.
Compartmental pressures should be measured as well.