English

Abstract

Snake bite is a major health concern in India. Common krait is one of the most dangerous and poisonous neurotoxic snakes. Snake bite is a medical emergency. India has the highest snake bite death rate in the world.1 Elapidae, viperidae, pit viper and hydrophiidae are the main poisonous snake families in India. Elapidae family includes common cobra, king cobra and common krait.2 Common Indian krait is about 10 times more poisonous than cobra. Snake toxins are neurotoxic or haematotoxic. Krait is neurotoxic, which interrupts neuromuscular transmission of impulse and causes paralysis of muscles. Neostigmine which is an anticholinesterase can reverse the neurological manifestations of the venom.3 Treatment of neurotoxic snake bite includes administration of anti-snake venom, neostigmine with atropine and invasive ventilation if there is respiratory muscle weakness or paralysis. Maximum dose of neostigmine to reverse neuromuscular blockade is 10 mg over 24 hours. 4 Here we report a case of a 60-years-old male who presented with a snake bite followed by respiratory distress and bilateral ptosis. The patient was treated as per standard protocol. However, his ptosis did not improve as per expectations. Hence, neostigmine was given for prolonged period to revert ptosis in neurotoxic snake bite. In this case study we are discussing about maximum dose of neostigmine given to revert ptosis in a neurotoxic snake bite, as their no case report regarding it.