Mohammad Asif Farooq, Shujaat Hussain.
Snake Bite in field areas.
Pak Armed Forces Med J Jan ;53(2):244-6.

A 35-year-old soldier was referred from in exercise area (1/2 hour drive from Gujranwala) on 16th July 2002 by surgical specialist, with one day history of pain abdomen. Detailed history revealed that he was sleeping on ground in a tent under a tree and when he woke up in the morning he had pain in epigastrium and throat and developed drooping of eye lids and generalized weakness over the next three hours. He was not aware of any snake or insects bite or eating any thing other than that cooked in cookhouse and taken by other men. There was no history of similar illness in other colleagues. He was admitted to surgical ward of CMH Gujranwala and was also reviewed by medical specialist on the same night. He was found to have bilateral ptosis and left 6th cranial nerve palsy, with motor power 4/5 in all four limb. He was observed in ITC, given intravenous fluids, inj zantac and antibiotics. Over period of time his symptoms aggravated and he was transferred to MH Rawalpindi next afternoon. At MH Rawalpindi, on examination he was fully conscious, haemodynamically stable, had bilateral ptosis, areflexia with muscle power 4/5 in all four limbs. Provisional diagnosis considered at this stage included: Guillian Barre (GB)Syndrome,FM variant, Myasthenia Gravis, Porphyria, Hypokalaemia However, possibility of snake or some other insect bite was also kept in mind. Neostigmine test was negative, with no evidence of hypokalaemia in ECG and serum electrolytes were normal. He was observed according to standard protocol for GB syndrome. His ptosis and weakness improved significantly over the next 48 hours and was able to walk normally. He was found to have normal results of investigations including Electromyography and Nerve Conduction Studies (EMG/NCS).

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com