Journal of Health and Medical Sciences
Published: 18 August 2020
Case Report: Management of Respiratory Failure Following Snake Bite
Mira Rellytania Sabirin, Reza Widianto Sudjud, Suwarman, Erwin Pradian
Soreang General Hospital (Indonesia), Universitas Padjajaran (Indonesia)
Download Full-Text Pdf
Keywords: Anti Snake Venom, Neurotoxic, Respiratory Failure, Snake Bite
Venomous snakebite cases are life-threatening medical emergencies. Most deaths were caused by respiratory failure due to acute neuromuscular paralysis. In this case, a man, 17 years old, was treated for snakebite on his upper arm one-hour prior hospital admission. Snakes was identified as cobras. Patient experienced symptoms of vomiting, seizures, headaches, weakness in the extremities and decreased consciousness. Local examination revealed two deep teeth marks. No hemorrhagic and myotonic manifestations were found. He then experienced respiratory failure, intubated and treated in the intensive care unit. Management of respiratory failure due to neurotoxic snake bites, namely administration of snake antivenom to bind poison, anti-cholinesterase and atrophine sulfate to release toxins from neuromuscular. Supportive therapy included ventilators, fluids, nutrition, tetanus toxoid, antibiotics. Fasciotomy was done on the bite wound because compartement syndrome was found. This patient did not show other abnormal manifestations because patient was promptly taken to the hospital. On day 3 hospital stay, he showed improvement, on day 6, he was moved to the ward. To achieve optimal results in cases of venomous snake bites, early diagnosis, early transportation to hospital and adequate management of snakebite were needed.
Agrawal, P. N., Aggarwal, A. N., Gupta, D., Behera, D., Prabhakar, S., & Jindal , S. K. (2001). Management of Respiratory Failure in Severe Neuroparalytic Snake Envenomation. Neurology India, 49(1), 25-8.
Anil, A., Singh, S., Bhalla, A., Sharma, N., Agarwal, R., & Simpson, I. (2010). Role of Neostigmine and Polyvalent Antivenom in Indian Common Krait (Bungarus Caeruleus) bite. Journal of Infection and Publich Health, 3, 83 -87.
Djunaedi, D. (2009). Penatalaksanaan Gigitan Ular Berbisa. In A. W. Sudoyo, B. Setiohadi, I. Alwi, M. K. Simdibrata, & S. Setiadi, Buku Ajar Ilmu Penyakit Dalam (5 ed., p. 280). Jakarta: Interna Publishing.
Hifumi, T., Sakai, A., Kondo, Y., Morine, N., Ato, M., Shibayama, K., . . . Kuroda, Y. (2015). Venomous Snake Bites: Clinical Diagnosis and Treatment. Journal of Intensive Care, 3(16).
Kakaria, A., Narkhede, M., Agrawal, S., Bhavsar, A., & Nukte, V. (2014). A Study of Outcome of Neuroparalytic Snake Bite Patients Treated with FIxed Dose Antisnake Venom. International Jounal Research in Medial Science (IJRMS), 4(2), 1676-82.
Kasturirane, A., Wickermasinghe, A., de Silva, N., Gunawardena, N., Pathmeswara, A., Premaratna, R., . . . de Silva, H. (2008). The Global Burden of Snakebita: A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths. PLoS Medicine, 5(11), e218.
kasturiratne, A., Wickremasinghe, A. R., de Silva, N., Premaratna, R., Savioli, L., Lalloo, D., . . . Pathmeswaran, A. (2008, 11). The Global Burden of Snake Bite: A Literautre Analysis and Modelling Based on Regional Estomates of Envenoming and Deaths. PLoS Medicine, 5(11), e218.
Niasari, N., & Latief, A. (2003). Gigitan Ular Berbisa. Sari Pediatri, 5(3), 92-93.
Ranakawa, U., Lalloo, D., & de Silva, H. (2013). Neurotoxicity in Snakebite: The Limits of Our Knowledge. PLoS Neglected Tropial DIsease, 7(10), e2302.
Sanmuganathan, P. S. (1998). Myasthenic Syndrome of Snake Envenomation: A Clinical and Neurophysiological Study. Postgrade Med J, 74, 596 - 599.
Warrell, D. (2010). Guidelines for the Clinical Management of Snake Bites in the South-East Asian Region. Thailand: World Health Organization. Regional Center for Tropical MEdicine, Faculty of Tropical Medicine, Mahidol University.
WHO. (2010). Guidelines for The Production Control adn Regulation of Snake Antivenom Immunglobulin. Geneva: World Health Organization. Retrieved from https://www.who.int/bloodproducts/snake_antivenoms/en/