Neurotoxic Snake Bite: Management

Principally there are two types of neurotoxic snakes seen in Indian subcontinent, namely Indian cobra and common krait. Venom acts at myoneural junction and paralyses muscle. Cobra bite has reversible action on muscle and patient responds to ASV and anti-cholinesterase; however common krait has irreversible action and patient may die due to bulbar and respiratory paralysis, thus may need to be kept on ventilatory support for longer time.

Case report: A 30 years old housewife got up in the morning and discovered, she was not able to open her eyes fully; she also noticed occasionally double vision.

Patient had slept last night on the floor on a mat. On closer observation, a painless bite mark was seen on the right arm. With passage of time patient complained of swallowing difficulty and nasal regurgitation of food. The treating doctor from his professional experience suspected a neurotoxic snake bite, and possibly a krait bite. Patient subsequently developed swallowing difficulty, muscular weakness and respiratory distress. Patient was immediately transferred to a hospital and connected to a ventilator. Patient was administered polyvalent Anti-Snake Venom (ASV) and injection neostigmine.

Over few hours, patient improved and herptosis and diplopia disappeared. Subsequently she was weaned off ventilator and within next two days patient was discharged.