Cobra snakebite mimicking brain death treated with a novel combination of polyvalent snake antivenom and anticholinesterase

In toxicology literature, snake bites were the second toxicology-relevant cause mimicking brain death. A 57-year-old woman with history of cobra snake bite. On examination, the brain stem reflexes were absent with Glasgow coma score of 3. The patient accomplished full neurological recovery after using a novel combination of Polyvalent Snake Antivenom (PSA) and anticholinesterases. This case highlights a unique presentation of cobra bite induced brain death mimicking. Thus, intensivist should exclude neuroparalytic effect of snakebite before considering withdrawal of ventilatory support or organ donation. Also, the life-threatening presentation of cobra envenomation mandates the use of higher doses of PSA to reverse the neuroparalytic toxicity. We should consider the rule of anticholinesterase as an adjunctive therapy to PSA in severe cobra envenomation.