Abstract
The clinical diagnosis of snakebite is critical, particularly in Southeast Asia where venomous snakebites are a public health concern. Additionally, cases involving unwitnessed snakebite with no species identification, especially in non-verbal children posed a challenge in the emergency setting. A 2-year-2-month-old boy presented to our emergency department with signs of neurotoxicity. He was restless and mildly bradypnoeic with the respiratory rate of 24 to 28 breaths per minute. He also had bilateral ptosis with absent gag reflex. There were faint fang marks noted over the medial aspect of his left ankle with local swelling and bruises, despite no history of animal bite and no eyewitness. A high index of suspicion of neurotoxic envenomation was prompted and a total of 6 vials of neuro-polyvalent anti-venom were administered in scheduled batches. Progressive clinical recovery was subsequently observed after the first batch of anti-venom administration. The case illustrated the importance of clinical recognition of neurotoxic envenomation in the absence of snake bite history or species identification. Early administration of anti-venom may potentially reverse the neurotoxic effects of systemic envenomation and saves lives.
Highlights
The clinical diagnosis of snakebite is critical before any decision on the necessary management can be planned, in the Southeast Asia where venomous snakebites are a public health concern
The case report illustrates the importance of clinical recognition of neurotoxic envenomation in the absence of snakebite history or species identification
The cluster of signs and symptoms present in this case underscores the rapidity of systemic envenomation and the diagnosis pitfall, that a clinician may mistaken a sign of neurotoxic paralysis for a drowsy child
Summary
The clinical diagnosis of snakebite is critical before any decision on the necessary management can be planned, in the Southeast Asia where venomous snakebites are a public health concern. Snakebites are commonly non-provocative in nature and there was a reported higher frequency of incidences during night times [1]. Lower limb was the commonest site of bites [1] as majority of snakebite cases are due to accidental stepping while walking or playing in the dark. There is various mode of clinical presentations in snakebite patients, which may either suggest a vasculotoxic or neuroparalytic nature of the afflicted snakebite. Coagulation failure is the commonest complication following vasculotoxic snakebite, followed by hypotension [2]. There was a higher risk of fatalities in victims of snakebite who reported to the hospital after more than six hours of the bite incident, among which majority died within 10 hours of hospitalization [1]
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