Autonomic Dysfunction Manifesting as Severe Hypertension Following Cobra Envenomation: An Unusual Occurrence

Abstract

Introduction: Envenomation due to an elapid snake (krait or cobra) bite is a common life-threatening medical emergency in India and is associated with significant morbidity and mortality. Common cobra (Naja naja) and common krait (Bungarus caeruleus) are the common snake species whose bites are associated with neuroparalysis, which is a key feature of envenomation. Autonomic dysfunction (AD) is another feature of envenomation with varied clinical presentations such as abdominal pain, vomiting, sweating, mydriasis, mild to moderate hypertension (HTN) or hypotension, and cardiac arrhythmia. The occurrence of AD manifesting as severe HTN and tachycardia is unusual following an elapid snake bite. This presentation has been frequently reported with krait envenomation but can also be observed with cobra envenomation.Case Report: We present the case of a 31-year-old male with common cobra (Naja naja) envenomation presenting with neuroparalysis along with severe HTN and tachycardia. The patient had a gradual and sustained recovery with anti-snake venom and other supportive care.Conclusion: Increasing incidences of cobra envenomation warrant that understanding its atypical presentation and its early recognition are of paramount importance as they may alter treatment decisions influencing the overall morbidity and mortality