The Indian Krait delivers one of the most deadly venoms compared to other Asian snakes. Common Krait’s venom contains substantial neurotoxins that cause muscle paralysis. Significant incidence of snakebites occurs in rural areas. The significant death rate caused by snakebites is rarely reported in the medical literature. A 14-year-old teenage girl was taken unconscious by her parents to the emergency room. The patient reported swelling on her right hand with snakebite fangs, sweating and increased salivation. The primary therapeutic intervention was given to the patient and she was treated with intravenous anti-snake venom serum, antibiotics and anticonvulsants during hospitalization.
Kraits usually bite at night when they enter homes in search of food . After neurotoxic poisoning caused by a common Krait bite, the patient needs a very large dose of polyvalent anti-snake venom (ASV) to overcome the neurological manifestations . All patients came from impoverished farming families living in villages, and the vast majority of them (96%) slept on the ground. Most bites occurred at night, as the victims slept on the floor .
High mortality from venomous snake bites is a serious health problem. It is a source of concern for medical professionals. Clinically, snakebite envenomation is divided into two categories: neurotoxic and vasculotoxic. Cobra and Krait are both neurotoxic. It is mainly composed of a very strong presynaptic neurotoxin that prevents impulses from being transmitted from nerve endings to muscle receptors. While the venom contains a few additional neurotoxic ingredients, it has no cytotoxic, hematotoxic, or other components . Death rates may be higher when patients do not have immediate access to life-saving anti-snake venom serum (ASVS), which is common in rural communities in developing countries .
A 14-year-old adolescent girl was taken unconscious to the emergency room by her parents with a complaint about a snakebite during the day. Primary preventive measures were taken by the doctor. Her parents said she was in her usual state of health until midday when they suddenly found their child out of the house and noticed a discolored bite mark on her right hand finger. The parents mainly visited the local doctor and he revealed a snake bite based on the physical examination and referred her to the multi-specialist hospital.
On physical examination, swelling on her right hand with a canine tooth, sweating, bradycardia, bradypnea, and salivation were noted. The vital signs included a heart rate of 30 bpm and were essentially near complete cardiac arrest with non-recordable other vital signs. Immediately, Pediatric Advanced Life Support (PALS) was initiated. After completion of three rounds of PALS, the carotid artery was palpable and the patient returned to spontaneous circulation (ROSC). The patient was moved to the pediatric intensive care unit (PICU) for further management (Figure 1).
On arrival at the PICU, the patient was intubated endotracheally. Simultaneously, the patient was administered intravenous snake venom antiserum in 20 vials, diluted with 10 ml of NS in each vial and 200 ml infused over 30 minutes. On laboratory examination, the complete blood count and renal function were all within the normal range. On the fourth day of admission, the patient’s vital signs were stable. Medical treatment continued and the prognosis for the patient was good.
In modern India, snakebite remains an underestimated cause of accidental death. The number of deaths from snakebite is 40 to 50 thousand per year, and most of the deaths occur in rural areas due to the poor availability of the health care system . Many superstitions and myths about snakebites cause a delay in receiving emergency treatment modalities for the patient. The neurotoxic snakebite is significantly associated with a high death rate from immediate respiratory failure, mostly in rural areas .
Many snakebite patients are treated and die outside of medical facilities, especially in rural India . The burden of snake bites is comparable to infectious diseases, as many people in rural areas have died over the years. For example, there is one death from snakebite for every two deaths from HIV in India. In addition, there is a need for education and awareness programs about snakebites in rural and urban areas that can prevent death .
The management of the clinical manifestation protocol of the Krait snakebite should be regulated. A snakebite patient needs good ventilation, primary emergency care, and maintenance of a normal blood pressure range; these can all improve patient prognosis and mortality . In the present case, the medical treatment was received on time and the patient was given a therapeutic intervention against poison. The patient’s prognosis was good and now she maintains her vital signs and is aware of time, place and person.
In India, deaths from the Krait snake are more common in rural areas due to the lack of awareness and education about the snake bite. There is a need for education and awareness programs for the rural population to know and understand the importance of hospitalization. Usually, rural people were first treated in the village by the local practitioner or the local person. There is a need to educate people about how to give first-line treatment as early as possible to reduce systemic poisoning and life-threatening symptoms. In this case, the patient lived near the hospital area and her parents immediately took her to the hospital. The patient received standard treatment during the golden period. As a result, her life was saved and the patient’s prognosis was good.