Case Reports on Sea Snake Envenomation

Two recent case reports published in the Journal of the Association of Physicians of India elaborate on the clinical features along with complications of Sea Snake envenomation in fishermen and highlight the treatment options.

Sea Snake bites are often neglected and poorly reported by the patients. The pathophysiology and clinical features in patients with significant envenomation are so rapid that life-threatening complications progress within minutes to a few hours and are often dramatic. There are a few case reports about Sea Snake envenomation in the International Toxicology Community.

Sea Snake Bite is a novel experience to many doctors. However, there is a lack of epidemiologic data concerning Sea Snake bites in India, which has a vast coastline.

Case 1

A 4-year-old fisherman who went fishing by boat in the Bay of Bengal was bitten by a sea snake. Within 60 minutes, he developed drooping of eyelids and myalgia.

At the time of hospital admission, he had drooping of eyelids, diplopia, slurring of speech, and difficulty in swallowing. He presented with neurological manifestations and also had myocarditis resulting in cardiogenic shock and pulmonary oedema.

He responded to medications, and reversal of LV dysfunction was also confirmed with a repeat echocardiogram.

Case 2

In yet another case, a 54-year-old fisherman with a normal medical history went fishing in the Ennore sea near Chennai. He was bitten by a sea snake while clearing the catch. Within minutes, he developed drooping of eyelids and slurring of speech. On being rushed to the hospital, he complained of drooping of eyelids and myalgia.

Severe rhabdomyolysis with hyperkalemia was detected in this patient, which deteriorated fast despite two cycles of hemodialysis and he died due to sudden cardiovascular collapse.

Management of Sea Snake Envenomation

"Management of Sea Snake envenomation involves resuscitation with airway care, breathing, and circulation (ABC) initially. A normal coagulation profile with absent local reaction at the bite site is a common presentation. Prompt recognition of clinical features and complications pertaining to rhabdomyolysis, myotoxicity, myocarditis, nephrotoxicity, and neurotoxicity is life-saving. Forced alkaline diuresis is useful when there is rhabdomyolysis with myoglobinuria in preventing catastrophic renal failure; however, cardiotoxicity, if present, restricts this option. Hence, hemodialysis will be the more appropriate therapy for severe rhabdomyolysis and renal toxicity. Continuous cardiac monitoring is very important for the first few hours as victims may develop acute cardiac decompensation, shock, and arrhythmias. In our country, specific anti-snake venom for Sea Snake envenomation is not available. However, in Australia, Tiger Snake Antivenom is being used because of the close relationship of Tiger snake and Sea snake venoms," wrote the team.

Primary source: The Journal of the Association of Physicians of India

For the full article, follow the link: https://www.japi.org/x2745434/case-reports-of-two-interesting-patients-with-sea-snake-envenomation