A life-threatening incidence of neurotoxic Indian krait snakebite: a case report

The Indian krait emits one of the deadliest venoms compared to other Asian snakes. Common Krait venom contains substantial neurotoxins that cause muscle paralysis. The significant incidence of snake bites occurs in rural areas. The significant mortality rate caused by snakebites is rarely reported in the medical literature. A 14-year-old girl was brought to the emergency department (ED) by her parents in an unconscious state. The patient reported swelling on her right hand with fang marks from a snake bite, sweating, and increased salivation. The primary therapeutic intervention was administered to the patient and she was treated with intravenous anti-snake venom serum, antibiotics and antiepileptics during hospitalization.

Introduction

Kraits typically bite at night when they enter dwellings in search of food. [1]. After neurotoxic envenomation caused by a common Krait bite, the patient requires a very high dose of polyvalent anti-snake venom (ASV) to overcome the neurological manifestations. [2]. All the patients came from impoverished farming families living in villages and the vast majority of them (96%) slept on the floor. Most of the bites occurred at night while the victims were sleeping on the ground. [3].

High mortality from toxic snakebite is a serious health concern. It is a source of concern for medical professionals. Clinically, snakebite envenomation falls into two categories: neurotoxic and vasculotoxic. Cobra and Krait are both neurotoxic. It consists mainly of a very potent presynaptic neurotoxin that prevents impulses from nerve terminals from being transferred to muscle receptors. Although the venom contains some additional neurotoxic ingredients, it has no cytotoxic, hematotoxic, or other components. [4]. Case-fatality rates may be higher when patients do not have immediate access to life-saving anti-snake venom serum (ASVS), which is prevalent in rural communities in developing countries. [5].

case presentation

A 14-year-old girl was brought to the emergency room by her parents in an unconscious state with a complaint of snakebite during the day. The primary preventive measures were taken by the doctor. Her parents stated that she was in her usual state of health until the afternoon when they suddenly found her son unconscious at home and noticed a bite mark on her right finger with discoloration. . Her parents mainly visited the local area doctor and based on the physical examination, it revealed a snake bite and referred her to the multi-specialty hospital.

Physical examination revealed swelling in the right hand with a fang mark, sweating, bradycardia, bradypnea, and salivation. Vital signs included a heart rate of 30 bpm and was essentially approaching complete cardiac arrest with other vital signs not recordable. Pediatric advanced life support (PALS) was started immediately. After completing three rounds of PALS, the carotid pulse was palpable and the patient returned to spontaneous circulation (ROSC). The patient was transferred to the pediatric intensive care unit (PICU) for further management (Figure 1).

Upon arrival at the PICU, the patient was endotracheally intubated. Simultaneously, snake venom antiserum was intravenously administered to the patient in 20 vials, diluted with 10 ml of NS in each vial, and 200 ml was administered over 30 minutes. On laboratory investigation, the complete blood count and renal function were all within the normal range. On the fourth hospital day, the patient’s vital signs were stable. Medical management continued and the patient’s prognosis was good.

Discussion

In modern India, snakebite remains an underestimated cause of accidental death. Snakebite death is 40 to 50 thousand per year, and most deaths occur in rural areas due to the poor availability of the health system. [6]. Many superstitions and myths regarding snake bites result in a delay in receiving emergency treatment modalities for the patient. Neurotoxic snakebite is significantly associated with a high mortality rate from immediate respiratory failure, especially in rural areas [7].

Many snakebite patients are treated and die outside of medical facilities, especially in rural India. [8]. The burden of snake bites is similar to that of 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. In addition, there is a need for snakebite education and awareness programs in rural and urban areas that can prevent death. [9].

Management of the Krait snakebite clinical manifestation protocol should be foreseen. A snakebite patient requires adequate ventilation, primary emergency management, and maintenance of a normal blood pressure range; all this can improve the patient’s prognosis and mortality [10]. In the present case, medical management was received in time and therapeutic intervention with antivenin was administered to the patient. The patient’s prognosis was good and she now maintains her vital signs and is aware of time, place and person.

Conclusions

In India, mortality due to the Krait snake is more prevalent in rural areas due to lack of awareness and education about snakebite. There is a need for education and awareness programs so that the rural population is aware and understands the importance of hospitalization. For the most part, rural people were first treated in the village by the local doctor or local person. There is a need to educate people about the primary treatment that should be given as soon as possible to reduce systemic poisoning 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 line of treatment during the golden period. As a result, her life was saved and the patient’s prognosis was good.

Leave a Reply

Your email address will not be published.