Neurotoxicity following snakebite and the challenges of management in an urban area—a case report

Abstract

Snakebites disproportionately affect the lower socioeconomic segments of the society, people with poorly constructed houses, and those with limited access to education and health care. Cases of snakebite are rare in urban areas. Therefore, health centers located in urban areas are sometimes unprepared for managing cases of snakebite. Potent snake antivenoms are not available, and most healthcare workers lack basic training needed for the management of snakebite. Here, we report a case of 28-year-old cleric who was rushed to the accident and emergency unit of an urban tertiary hospital on account of snakebite injury involving the left forearm. At presentation, there was history of persistent vomiting and hypersalivation. However, there was no history of bleeding from the site of bite, hematemesis, hematuria, or bleeding from any orifice. He later became confused with altered level of consciousness, developed bilateral ptosis, and broken neck sign. The patient survived after receiving intravenous polyvalent snake antivenom (EchiTab-plus; Instituto Clodomiro Picado, Costa Rica), which was incidentally purchased for laboratory experiment and not for patient care. The case highlights the challenges frequently encountered in the management of snakebite victims, especially in nonendemic areas; it also stresses the need for urban health centers to stock snake antivenom in their pharmacy and train healthcare workers in the management and care of snakebite victims.