Since last Sunday, we had 3 patients with krait bites. On analysing the 3 patients, it is very interesting that we saw almost all varied features of krait bites.
Krait is known as 'the dirty snake' or the 'mysterious snake' among the big four in India - the other three being Russel's viper, cobra and the saw scaled viper. In fact, krait bites have baffled clinicians with it's varied presentations. A cursory google search yields varied and many a time contradictory findings across the regions where krait bites are seen.
Let me go to the first of three patients we had to treat this week - all of them needed ventilation.
The first patient, we'll call A. As she went to take water from a handpump, she had put her foot into a puddle of water and she felt something wiggling under her leg. She had pulled out her leg and she did not feel any pain. Later, she developed some sort of a funny feeling of her legs giving way and a sore throat. Her parents attributed it to a fever she had couple of days back. She had mentioned about the snake which grazed her feet.
The parents were wise enough to bring her to the hospital. By the time she reached, she was gasping with a falling oxygen saturation. It was not difficult for my colleagues to diagnose a neurotoxic snake bite. Within no time, she was intubated.
And she slept for a full 3 days without any sign of life except for her heart beat and sluggishly reacting pupils. In addition, she had high blood pressure readings which did not respond to any anti-hypertensive medication as well as high grade fever which did not respond to Paracetamol or other NSAIDs.
It was difficult for her parents to accept that it was a snake bite. In between they suggested that her condition had something to do with her fever couple of days back. To convince the parents, we did blood tests which all came out to be normal.
On the fourth day, she showed signs of arousal. She slowly started to move her eyelids, fingers and toes. And by Friday morning, she was off the ventilator. However, even today, she had only Grade 4 strength of her muscles. Today (Sunday, the 14th June, 2015),
It was good she was off the ventilator on Friday as we had another krait bite patient on Friday midnight. More on the next patient in my next post.
Now, lessons on krait bite from this patient.
- A BITE MARK NEED NOT BE PRESENT ON A KRAIT BITE VICTIM.
- THE RELATIVES NEED TO BE WARNED ABOUT PROLONGED PERIODS OF VENTILATORY SUPPORT WHICH COULD BE ASSOCIATED WITH COMPLICATIONS
- THE HIGH BLOOD PRESSURE AND FEVER ARE COMMONLY SEEN FEATURES OF KRAIT BITES.
- IF YOU SUSPECT KRAIT BITE, ENSURE THAT FACILITIES ARE AVAILABLE FOR INTUBATION AND VENTILATION. Our experience shows that we do not need high end machines for ventilation. Because of cost constraints, we use the Newmon Ventilator, which we used at NJH too. At a cost of around 80,000 INR, it is much more affordable for smaller hospitals in comparison to high endventilators which is more than 10 times costly.
Look out for the next post, which should as soon as our second patient comes out of coma . . . A third patient has just come in and got intubated. As the second patient is hooked on the only ventilator that we have, the third patient is being manually bagged. Pray for them . . .