Case reports

Sri Lanka
Theakston et al. 1990b: 2 Naja n. naja bites; identification: Naja n. naja venom antigen with ELISA.

Local envenoming:

• extent of the swelling (grade 1–6; scale of Warrell et al. 1974).
• intensity of the swelling (measurement method of Reid et al. 1963c).

Systemic envenoming:

• neurological signs and symptoms.

Signs & symptoms

Local effects

Pain at the site of the bite and extensive local swelling: grade 6, maximum increase in the circumference of the affected extremity 17.2% in 1/2 patients, later extensive necrosis; grade 5, maximum increase in the circumference of the affected extremity 13.4% in 1/2 patients, later necrosis (Theakston et al. 1990b).

Neurological effects

Preparalytic phase 3.5 h (dysphagia).

Double images, ptosis, dysphagia, dysphasia, generalised muscle weakness, paralysis of the respiratory musculature with respiratory failure (1/2) (Theakston et al. 1990b).

Other signs & symptoms

Vomiting 1/2 (Theakston et al. 1990b).

Case fatality rate

0/2 (Theakston et al. 1990b).

Morbidity

Necroses 2/2 (Theakston et al. 1990b).

Laboratory and physical investigations

1. Haemostatic parameters
Platelet count and blood clotting tests in the normal range in 2/2 patients (Theakston et al. 1990b).

2. Leucocytes
Leucocytosis 2/2 (Theakston et al. 1990b).

3. ELISA
Venom antigen detectable in serum 2/2 (Theakston et al. 1990b).

First aid

In animal experiments, compression-immobilisation of the affected extremity effectively delayed the uptake of venom from the site of the bite into the systemic circulation (Sutherland et al. 1981b). The swelling caused by marked local effects is a problem, as it can rapidly turn this first aid method into a form of arterial ligation, as well as the fact that the local effects are thereby increased.

Treatment (specific)

Antivenom

Polyvalent antisnake venom serum (Haffkine, Mumbai).

Efficacy

1. Local envenoming (swelling, necrosis): no effect 2/2 (Theakston et al. 1990b). The limited number of patients makes it impossible to draw any conclusions regarding efficacy.
2. Systemic envenoming (neurological signs and symptoms): in 1/2 patients who suffered complete respiratory paralysis and who received antivenom treatment, the following course was observed: 300 ml of antivenom were administered within 1.5 h; 1 h after the third dose there was dramatic improvement of the neurological symptoms. 2 h after antivenom administration, venom antigen was no longer detectable in serum; however, venom antigenaemia re-occurred 65 h after the administration of antivenom (Theakston et al. 1990b). The limited number of patients makes it impossible to draw any conclusions regarding efficacy.

Side effects
Polyvalent antisnake venom serum (Haffkine, Mumbai): see Biomedical database entry Daboia russelli pulchella.