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CASE REPORTS

DOI : 10.7199/ped.oncall.2012.55
   
 
SEVERE NEUROPARALYTIC SNAKE BITE
Garg Padma Parvesh, Garg Parvesh Mohan, Ravi Tarun K.
Department of Pediatrics, Babu Jagjivan Ram Memorial Hospital, Delhi Government Hospital, New Delhi, India.
 
Abstract

Three patients with severe neuroparalytic snake envenomation were admitted in our intensive care unit over one month period. Initially, ptosis and ophthalmoplegia occurred followed by areflexia, bulbar palsy, respiratory muscle weakness and loss of brain stem reflexes mimicking brain death chronologically. They received cardiopulmonary support with mechanical ventilation, anti-snake venom (median dose of 20 vials) and anti-cholinesterase therapy. Mechanical ventilation was continued despite features suggestive of brain stem dysfunction. They required mechanical ventilation for 8, 5 and 2 days respectively. Except one patient suffering from residual weakness of lower limb, the rest survived with complete neurological recovery. Neuroparalysis is known with cobra envenomation but the prolonged loss of brain stem reflexes can be difficult to interpret for the caregivers about the efficacy of the treatment. However, good outcome in such cases is related to early cardiopulmonary support and anti-venom therapy.
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