Delayed Neurotoxic Paralysis with Confounding Hypokalaemia

Utsav Anand Mani, Mukesh Kumar, Haider Abbas, Pranay Gupta
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Abstract

Snakebite is a major health issue in India and developing nations across the globe. Common krait bites are associated with delayed paralysis and locked-in syndrome. Locked-in syndrome has been documented among patients of snakebite. Our case is unique due to the confounding effect of hypokalaemia which may confuse the physician as hypokalaemic periodic paralysis (HPP), a rare genetic condition which can also be precipitated by a stressful event such as snakebite. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. As krait bite are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. We urge our fellow researchers to look out for similar findings in their patients. Key messages: Locked-in syndrome in snakebites can be due to the effect of the venom in blood onto the ventral pons. To the best of our knowledge, we could not associate the presence of hypokalaemia in patients of neurotoxic snakebite. We presume this hypokalaemia to be nutritional in origin. As krait bites are often not associated with the history of having witnessed, a snake due to its nocturnal habit and painless bite, such hypokalaemia should not lead the physician to misdiagnose this snakebite as severe HPP. Keywords: Case report, Hypokalaemia, Neurotoxic, Snake envenomation
伴有低钾血症的迟发性神经中毒性麻痹
蛇咬伤是印度和全球发展中国家的一个主要健康问题。常见的蛇咬伤与迟发性瘫痪和锁定综合征有关。在被蛇咬伤的患者中,有锁闭综合征的记录。我们的病例比较特殊,因为低钾血症的混杂效应可能会让医生误认为是低钾血症性周期性麻痹(HPP),这是一种罕见的遗传病,也可能由蛇咬伤等应激事件诱发。据我们所知,我们无法将神经毒性蛇咬伤患者出现低钾血症联系起来。由于蛇的夜间习性和无痛性,被蛇咬伤的患者通常没有目击蛇的历史,因此这种低钾血症不应该导致医生将蛇咬伤误诊为严重的 HPP。我们敦促研究人员在他们的患者中留意类似的发现。关键信息蛇咬伤锁定综合征可能是由于血液中的毒液对腹侧脑桥的影响。据我们所知,神经毒性蛇咬伤患者中不存在低钾血症。我们推测这种低钾血症是营养性的。由于蛇的夜间活动习性和无痛咬伤,被蛇咬伤的患者通常没有目击蛇的历史,因此这种低钾血症不应该导致医生将这种蛇咬伤误诊为严重的 HPP。关键词病例报告 低钾血症 神经毒性 蛇咬伤
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