A farmer, who is nearly brain dead saved by KIMS Icon doctors

Visakhapatnam, 30th March 2023: A farmer, who suffered from abdominal pain early in the morning, and lost consciousness later, almost went into a state of brain death. He is now fully recovered with the timely treatment provided by KIMS Icon doctors. Dr. Ch. Vijay, consultant neuro-surgeon, KIMS Icon Hospital, Visakhapatnam, explained the plight of a 30-year-old farmer from the Chodavaram area of Visakhapatnam district and the treatment.

"The 30-year-old farmer complained of stomach pain at around 6 am in the morning. He was referred to a local doctor, who suggested a scan. As the scanning was not possible at that time, he was taken back home. After two hours, he was unable to breathe properly. Gradually, his limbs became weak, restricting his mobility. His condition was not very hopeful, so he was immediately brought to KIMS Icon hospital. By the time he arrived, the man was almost in a coma condition, his eyes were not opening, he was immobile and was unable to speak. Once examined, there was pulse. So, we intubated to help him breathe immediately. Neurological examinations showed that the patient's internal systems were fine. Cranial nerve examination showed bilateral complete ophthalmoplegia, which means his eyes are not responsive. Facial nerves are fine. On examination of the body, there were no signs of snakebite or scorpion bite. But at the same time, there are differences like heavy breathing, the heart beating more than 100 times per minute, fluctuations in blood pressure. CBC, liver function test and renal function test are all normal. MRI was done on the brain and spine. They came out normally. Yet, his breath was not normal. So we had to continue the ventilator.

The patient's condition has not improved much despite giving Atropine and Neostigmine to resolve neuromuscular junction (NMJ). Then we gave him the snake venom antidote. Then slowly, there was an improvement in eyesight and the tilting of the eyelid. Gradually, we have started giving medicines to improve the remaining organs.

We gave Calcium gluconate every six hours. Neostigmine continued intravenously for three days. Gradually, breathing has stabilised and the muscle weakness decreased. On the seventh day, we have extubated the farmer. Even after that, the patient developed gram negative sepsis, and was started on IV antibiotics.

With all the symptoms, we thought so that he might have bitten by a krait. There is a possibility of such bites due to the lack of proper protection of the legs while roaming in the fields. Sometimes their fang marks are visible, sometimes they are not visible. Such a problem caused by snakebite is called early morning paralysis. If not detected and treated promptly, the patient may gradually go into a coma and lose his life. No matter how poisonous the snake bites, if the treatment starts in the hospital within two to three hours, there is a possibility of saving lives. Even if it is not detected as a snake bite, it is important to take it to the doctor immediately in case of such a problem," explained Dr. Ch. Vijay.