A life-threatening case of the neurotoxic Indian Cretan snake bite: a case report

The Indian krait delivers one of the deadliest venom compared to other Asian snakes. Common krait poison contains large neurotoxins that cause muscle paralysis. Snake bites occur largely in rural areas. Significant mortality from snakebites is rarely reported in the medical literature. A 14-year-old teenage girl was brought by her parents to the emergency department (ED) in an unconscious state. The patient reported swelling of her right hand with canine signs of snake bite, sweating and increased salivation. The patient was given the initial therapeutic intervention and she was treated with intravenous anti-snake venom serum, antibiotics and anti-epileptics while she was in the hospital.

an introduction

Krits usually bite at night when they enter dwellings in search of food [1]. After the neurotoxicity caused by the bite of a common krait, the patient requires a very large dose of anti-snake venom (ASV) to overcome the neurological manifestations. [2]. All patients were from poor farming families living in villages, and the vast majority (96%) of them slept on the floor. The majority of bites occurred at night while the victims were sleeping on the floor [3].

The high mortality rate from venomous snakebites is a serious health problem. It is a concern for medical professionals. Clinically, snakebite poisoning falls into two categories: neurotoxic and vasotoxic. Cobra and krait are both neurotoxic. It mainly consists of a very powerful presynaptic neurotoxin that prevents impulses from nerve endings from transmitting to muscle receptors. Although the venom contains few additional neurotoxic components, it does not contain cytotoxic, hemotoxic or other components. [4]. Case-fatality rates can be higher when patients do not have immediate access to life-saving anti-snake venom serum (ASVS), which is common in rural communities in developing countries. [5].

View status

A 14-year-old teenage girl was brought by her parents to the emergency department in an unconscious state with a daytime snake bite complaint. Initial preventive measures were taken by the doctor. Her parents mentioned that she was in her usual health until the afternoon when they suddenly found their child unresponsive at home and noticed a bite mark on her right finger with discoloration. The parents primarily visited the local area doctor and he detected a snake bite based on a physical examination and referred her to the multispecialty hospital.

On physical examination, swelling of her right hand with a canine mark, sweating, bradycardia, slow breathing, and drooling was noted. Vital signs included a heart rate of 30 bpm and were essentially near complete cardiac arrest with other non-recordable vital signs. The Pediatric Advanced Life Support (PALS) program began immediately. After completing three rounds of PALS, the carotid pulsation was evident and the patient was back on spontaneous circulation (ROSC). The patient was transferred to the Pediatric Intensive Care Unit (PICU) for further management (Fig 1).

Upon arrival in the pediatric intensive care unit, the trachea was intubated. Simultaneously, the patient was administered intravenous snake antivenom in 20 vials, diluted with 10 mL NS in each vial, and administered 200 mL over 30 min. On laboratory examination, complete blood count and kidney function were within the normal range. On the fourth day of hospital admission, the patient’s vitality was stable. Medical management continued and the patient’s prognosis was good.

Discuss

In modern India, snakebites are still an underestimated cause of accidental death. Deaths from a snake bite range from 40 to 50 thousand annually, and most deaths occur in rural areas due to poor availability of the health care system. [6]. Many myths and legends about snakebites delay a patient’s emergency treatment. Neurotoxic snake bite is closely associated with high mortality rate due to immediate respiratory failure, mostly in rural areas. [7].

Many patients who suffer from snake bites and die are treated outside medical facilities, especially in rural India [8]. The burden of snake bites is similar to infectious diseases because many people in rural areas have died over the years. For example, there is one snakebite death for every two HIV deaths in India. Furthermore, there is a need for education and awareness programs about snakebites in rural and urban areas that can prevent death. [9].

A management protocol for the clinical manifestations of a krait snake bite should be provided. A patient with a snake sting requires proper ventilation, initial emergency management, and maintenance of a normal blood pressure; All of this can improve prognosis and mortality [10]. In the present case, medical management was received on time, and the antitoxin therapeutic intervention was administered to the patient. The patient’s prognosis was good, she now maintains her vital signs and is conscious of time, place and person.

Conclusions

In India, the mortality rate due to the Cretan snake is more prevalent in rural areas due to the lack of awareness and education regarding the snake bite. There is a need for educational and awareness programs for the rural population to be aware and understand the importance of hospitalization. Rural people were mostly treated first in the village by the local practitioner or local person. There is a need to educate people regarding the need to provide initial treatment as soon as possible to reduce systemic toxicity and life-threatening symptoms. In this case, the patient lived near the hospital area, and her parents immediately took her to the hospital. The patient received a standard treatment line during the golden period. Because of that, she saved her life and the patient’s prognosis was good.