Cobra snakebite mimicking brain death treated with a novel combination of polyvalent snake antivenom and anticholinesterase

Am J Emerg Med. 2020 Nov;38(11):2490.e5-2490.e7. doi: 10.1016/j.ajem.2020.05.111. Epub 2020 Jul 6.

Abstract

In toxicology literature, snake bites were the second toxicology-relevant cause mimicking brain death. A 57-year-old woman with history of cobra snake bite. On examination, the brain stem reflexes were absent with Glasgow coma score of 3. The patient accomplished full neurological recovery after using a novel combination of Polyvalent Snake Antivenom (PSA) and anticholinesterases. This case highlights a unique presentation of cobra bite induced brain death mimicking. Thus, intensivist should exclude neuroparalytic effect of snakebite before considering withdrawal of ventilatory support or organ donation. Also, the life-threatening presentation of cobra envenomation mandates the use of higher doses of PSA to reverse the neuroparalytic toxicity. We should consider the rule of anticholinesterase as an adjunctive therapy to PSA in severe cobra envenomation.

Keywords: Anticholinestrase; Brain death mimiking; Cobra snake bite; Polyvalent snake antivenom.

Publication types

  • Case Reports

MeSH terms

  • Animals
  • Antivenins / therapeutic use*
  • Atropine / therapeutic use
  • Brain Death / diagnosis
  • Cholinesterase Inhibitors / therapeutic use*
  • Diagnosis, Differential
  • Elapid Venoms / poisoning*
  • Elapidae
  • Female
  • Humans
  • Immunologic Factors / therapeutic use*
  • Middle Aged
  • Neostigmine / therapeutic use
  • Neurotoxicity Syndromes / diagnosis
  • Neurotoxicity Syndromes / etiology
  • Neurotoxicity Syndromes / therapy*
  • Pyridostigmine Bromide / therapeutic use
  • Recovery of Function
  • Saudi Arabia
  • Snake Bites / diagnosis
  • Snake Bites / therapy*

Substances

  • Antivenins
  • Cholinesterase Inhibitors
  • Elapid Venoms
  • Immunologic Factors
  • Neostigmine
  • Atropine
  • Pyridostigmine Bromide