Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation

The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious pati...

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Main Authors:	Ahmad Khaldun Ismail, Mohd Fyzal B, Soo, CI, Yeap, BT, Mohamed Faisal AH
Format:	Article
Language:	English
Published:	Pusat Perubatan Universiti Kebangsaan Malaysia 2017
Online Access:	http://journalarticle.ukm.my/12699/ http://journalarticle.ukm.my/12699/ http://journalarticle.ukm.my/12699/1/22_khaldun_et_al_pdf_36414.pdf

id	ukm-12699
recordtype	eprints
spelling	ukm-126992019-03-17T12:24:39Z http://journalarticle.ukm.my/12699/ Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation Ahmad Khaldun Ismail, Mohd Fyzal B, Soo, CI Yeap, BT Mohamed Faisal AH, The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support. Pusat Perubatan Universiti Kebangsaan Malaysia 2017 Article PeerReviewed application/pdf en http://journalarticle.ukm.my/12699/1/22_khaldun_et_al_pdf_36414.pdf Ahmad Khaldun Ismail, and Mohd Fyzal B, and Soo, CI and Yeap, BT and Mohamed Faisal AH, (2017) Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation. Medicine & Health, 12 (2). pp. 357-362. ISSN 2289-5728 http://www.medicineandhealthukm.com/toc/12/2
repository_type	Digital Repository
institution_category	Local University
institution	Universiti Kebangasaan Malaysia
building	UKM Institutional Repository
collection	Online Access
language	English
description	The incidence of envenoming from king cobra, Ophiophagus hannah in human is relatively rare. Its venom acts on the postsynaptic region of the neuromuscular junction causing descending flaccid paralysis. Locked-in syndrome is a clinical state of inability to provide motor response in a conscious patient. Many reported cases of locked-in syndrome following neurotoxic snake-bite mimics brain death. We report a case of a middle aged man who presented with progressive neurological deficit following a king cobra bite over his right arm. He had local and systemic neurotoxic envenoming. His condition deteriorated, and was intubated and ventilated in the emergency department. He received a total of 33 vials of the Ophiophagus hannah monospecific antivenom and subsequently recovered well with no neurological deficit. Retrospectively, he was able to recall the events and while he was lying paralysed and intubated under minimal sedation in the intensive care unit. He described it as a terrifying and painful experience. This case highlights the rare presentation of locked-in syndrome following a systemic envenoming from a king cobra bite. It is important to differentiate neurotoxic snake envenoming lock-in syndrome from brain dead. Patients are unable to respond to physical pain and require adequate analgesia. A patient suffering this highly distressing experience may require psychological support.
format	Article
author	Ahmad Khaldun Ismail, Mohd Fyzal B, Soo, CI Yeap, BT Mohamed Faisal AH,
spellingShingle	Ahmad Khaldun Ismail, Mohd Fyzal B, Soo, CI Yeap, BT Mohamed Faisal AH, Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation
author_facet	Ahmad Khaldun Ismail, Mohd Fyzal B, Soo, CI Yeap, BT Mohamed Faisal AH,
author_sort	Ahmad Khaldun Ismail,
title	Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation
title_short	Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation
title_full	Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation
title_fullStr	Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation
title_full_unstemmed	Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation
title_sort	locked-in syndrome following a king cobra (ophiophagus hannah) envenomation
publisher	Pusat Perubatan Universiti Kebangsaan Malaysia
publishDate	2017
url	http://journalarticle.ukm.my/12699/ http://journalarticle.ukm.my/12699/ http://journalarticle.ukm.my/12699/1/22_khaldun_et_al_pdf_36414.pdf
first_indexed	2023-09-18T20:03:11Z
last_indexed	2023-09-18T20:03:11Z
_version_	1777406985561440256

Locked-in syndrome following a king cobra (Ophiophagus hannah) envenomation

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