Comatose Child with a Cobra Bite Exhibiting Sudden Cardiac Arrest

A 2-year-old boy was brought to the emergency department after experiencing sudden cardiac arrest of unknown cause. Prior to the arrest, his right foot had accidentally gotten trapped in floor gaps, submerging it in sewage. Shortly afterward, he exhibited signs of distress, collapsed, and required immediate cardiopulmonary resuscitation (CPR) and intubation. 

The child had been generally healthy since birth and prior to this accident.

Upon examination, he was comatose with fluctuating vital signs, fixed pupils, and absent reflexes. Laboratory tests were unremarkable. Brain imaging revealed generalized brain edema. 

Despite treatment, including Thai cobra antivenom initiated due to suspicions of snake envenomation, he remained comatose. Minimal movements were observed 20 minutes after antivenom administration at the distal extremities – eyes and limbs. The child could be successfully extubated within a day. Subsequent rehabilitation led to gradual recovery over a few weeks without lasting neurological deficits. 

ELISA testing confirmed cobra venom exposure.

This case highlights the importance of considering snake envenomation in sudden cardiac arrest cases, even without visible fang marks. It also emphasizes the role of EEG in assessing comatose patients with an absence of brainstem reflexes, especially when findings contradict clinical presentation. Early administration of antivenom can prevent fatality––underscoring the significance of prompt diagnosis and treatment in snakebite cases.

Source:Mekmangkonthong A, Khusiwilai K, Paticheep S, Tiacharoen D. Case Reports in Pediatrics. 2024 Jan 9;2024.