Objective: To identify the early predictors of severe envenomation in the southern region of Tunisia. Methods: It was a retrospective monocentric study including consecutive patients admitted to the emergency department for snakebite envenomation. Snakebite envenomation was defined by a history of snakebite. Predictors of severe envenomation were determined by univariate and multivariate analyses. Results: Our sample consisted of 109 patients aged 30 (20-44) years with a 1.1:1 sex-ratio (56 males and 53 females). During the 24-hour surveillance period, 25 patients developed severe envenomation (22.9％). The in-hospital mortality rate was 4.6％ (n=5). The independent predictors of severe snakebite envenomation were leucocyte count over 11550/mm3 (OR: 18.7, 95％ CI: 3.3-107.8), creatine kinase over 155 IU/L (OR: 6.16, 95％ CI: 1.1-35.6), and/or tourniquet before arrival to the ED (OR: 32.14, 95％ CI: 3.5-295.9). Conclusions: This study emphasizes the importance of early evaluation of snakebite envenomation. Further studies are required to approve a severity scale proper to snakebite envenomation in Tunisia.