Systemic effects with CNS involvement are signs of severe envenomation. Such severe systemic involvement appears to be the result of massive release of catecholamines by the victim's adrenal glands. Any of the following signs or symptoms is cause for concern: fever, excessive salivation, involuntary tearing, nausea or vomiting, confusion, coma, convulsions, increased or decreased heart rate or blood pressure, increased or involuntary defecation or urination, increased fluid excretion into the bronchioles and lungs, or swelling of the lungs. Death is usually due to heart or respiratory failure.