1Assistant Professor, 2Professor, Madras Medical College, Chennai, Tamil Nadu Received: 03.08.2017; Accepted: 15.09.2019
Sea Snakes have the most potent venom among snakes known to mankind and a few species are implicated in human fatalities.1 Commonest Sea snake in the Indian Sea is Enhydrina Schistosa.2 Mortality is high in spite of therapy because of multiple complications. This is a Case report of two Fishermen who were bitten by Sea Snake and developed complications.
Sea snakes are marine reptiles and probably the most abundant reptile on Earth, mainly found in tropical and sub tropical waters of Indian Ocean and Pacific ocean.3 Sea snakes are closely related to Australian Elapids with two subfamilies, Hydrophiinae and Laticaudinae. The Sea snakes are distinguished from the land snakes by their laterally compressed Fin like tail (Figure 1). This paddle like tail is their characteristic feature which increases their swimming ability. The venom apparatus of Sea snakes are rudimentary with 2-4 short hollow maxillary fangs associated with a pair of venom producing glands. Though all Sea Snakes are venomous, majority (80%) of them fail to produce any features of envenomation because of their shallow fangs and insignificant venom injected upon the victim. Usually bite does not produce any pain or evoke inflammatory response. In several areas of Coromandel coast (East coast of India), Enhydrina Schistosa is the sea snake most frequently encountered or caught by humans.2
Enhydrina Schistosa commonly called as Hooknosed or Beaknosed sea snake in ENGLISH and ‘Valakadyn’ meaning –‘Strong Biter’ in Tamil. Heatwole describes that majority of death due to sea snakes are because of E. schistose.4,9 Its venom is very potent and toxic. Most often the victims of sea snake bites are fishermen because of their profession. Here we present case records of two victims of sea snake envenomation.
Case summary 1
- 4 year old fisherman went for fishing by boat in the Bay of Bengal 7 kms from Thiruvottriyur beach near Chennai on 23/7/15. Around 11:00 am, while he was sorting out the fishes in the net, the sea snake which was in the net has bitten his right thumb. Within 60 minutes he developed drooping of eye lids and myalgia. He was rushed to the shore immediately and taken to a nearby private hospital, he was then referred to Government General Hospital, Madras Medical College for further management. He was admitted in GH on 23/7/15 afternoon.
- At the time of admission he had drooping of eyelids, diplopia, slurring of speech and difficulty in swallowing (Figure 2). EOM Restricted in all directions. Pt was tachypneic with a Respiratory rate of 28/min and low Spo2. JVP not elevated. No h/o local pain and swelling over the bite site. Cardiac Examination revealed tachycardia, hypotension, normal Heart sounds with no murmur. Respiratory examination revealed bilateral air entry with fine Inspiratory crackles upto midscapular region.
- In view of RespiratoryDistress pt was immediately intubated and started on mechanical ventilation with appropriate settings. ET showed pink frothy secretions s/o Pulmonary Oedema. Bedside ECG- showed sinus tachycardia. Whole Blood Clotting Time (WBCT) done at the time of admission and further repeated tests at appropriate intervals were normal. Patient was started on Injection Dopamine infusion for correcting hypotension and further dose titrated according to BP.
- Urgent bed side Echocardiography was done. It revealed reduced Ejection Fraction, DYSKINETIC LV APEX and IVS with normal Valves and no pericardial effusion.