Guwahati: A suspected neurotoxic snakebite left a young tea-garden worker in Assam’s Sivasagar district paralysed and struggling to breathe, but timely airway management and prolonged ventilation helped her survive the life-threatening envenomation.
The woman was bitten on her foot at around 11.30am on September 16 while working in a tea garden. According to the patient and her co-workers, the snake appeared completely white after she accidentally stepped on it.
She was brought to Demow Community Health Centre (CHC) around 50 minutes after the incident.
Initially, the bite did not appear severe. She had neither significant swelling nor clearly visible fang marks. When medical staff showed her photographs of venomous snakes commonly found in Assam, she repeatedly identified the snake as white.
Her condition changed within a couple of hours.
At around 1.40pm, a health worker noticed that she had developed drooping eyelids and double vision. The symptoms indicated possible neurotoxic envenomation, prompting doctors to begin treatment.
She received 20 vials of polyvalent anti-snake venom (ASV), along with neostigmine and glycopyrrolate. However, the ptosis persisted despite five maintenance doses.
As her neurological condition worsened, doctors suspected presynaptic neurotoxicity associated with a Bungarus species and stopped the anticholinesterase treatment.
The woman subsequently developed descending flaccid paralysis, paradoxical abdominal breathing and progressive respiratory failure.
By around 3.30pm, doctors at Demow CHC intubated her.
However, the facility did not have mechanical ventilation. The medical team therefore manually ventilated the patient with an Ambu bag while she was transported by ambulance to a collaborating private intensive-care facility. Manual ventilation was maintained throughout the journey.
By approximately 5pm, she had developed complete flaccid paralysis and required mechanical ventilation after reaching the ICU.
Her recovery was gradual but successful. She was extubated around 30 hours after the snakebite. Her difficulty swallowing resolved by the fourth day, while the drooping eyelids and abnormal pupil responses had completely recovered by the eighth day.
The woman was discharged on September 22 without any residual neurological deficit, according to the treating team.
Dr Surajit Giri, a member of the National Technical Advisory Committee under the Ministry of Health and Family Welfare, said the case demonstrated the limitations of identifying a snake solely from its colour.
Snakes can occasionally have unusually pale or white appearances because of pigmentation conditions such as leucism or albinism. However, colour alone cannot reliably establish the species without examining the animal.
In this case, the woman’s clinical symptoms provided more important clues than the snake’s unusual appearance.
The early development of ptosis and double vision was particularly significant, as neurotoxic snake venom can progressively affect the muscles responsible for swallowing and breathing.
The case also highlighted the importance of emergency airway management in rural healthcare settings. Despite the absence of a mechanical ventilator at Demow CHC, the medical team was able to intubate the patient and maintain manual ventilation until she reached an ICU.
Doctors involved in the treatment advised people not to assess the severity of a snakebite based solely on the snake’s colour, the extent of swelling or the presence of visible fang marks.
They also warned against using tourniquets, cutting the bite wound, attempting to suck out venom or using other potentially harmful first-aid methods. Anyone suspected of having suffered a snakebite should be taken to a healthcare facility as quickly as possible.
The patient’s treatment at the private ICU was supported by the Venom Army network and community crowdfunding, which helped cover the cost of intensive care.
The case ultimately involved coordinated efforts by the patient’s family, the Venom Response Team, health workers at Demow CHC, the ICU team and members of the local community.
For the patient, the snake’s unusual appearance initially provided little indication of the severity of the bite. It was the rapid recognition of neurological symptoms and the decision to secure her airway before respiratory failure became irreversible that proved critical to her survival.