The role of pyridostigmine in recovery from motor paralysis in a snakebite patient with an allergic reaction to anti-snake venom

Abstract

A 30-year-old woman presented as an emergency with a history of snakebite 5 h previously with signs of bulbar palsy, ptosis, respiratory distress and weakness of all four limbs. Mechanical ventilation, anti-snake venom (ASV) and supportive management were immediately instituted. With the third dose of ASV, an early anaphylactic reaction ensued. Subsequent management with corticosteroids and antihistamines over the next few days allowed consciousness to return but muscle power did not improve beyond 2/5. A trial of intravenous neostigmine with glycopyrrolate, however, improved motor power in all four limbs to 3/5. Oral pyridostigmine at 60 mg every 8 h allowed subsequent full motor recovery in all four extremities. We suggest consideration of pyridostigmine to promote motor recovery after an allergic reaction to ASV.

Binocular Diplopia After A Snakebite

“…Sung and Hah 7 reported a case of extraocular muscle paresis following a snakebite. It was reported that a patient, supported with a mechanical ventilator due to the neuromuscular paralysis, which was developed about 5 hours after snakebite, was resuscitated successfully using intravenous neostigmine and oral pyridostigmine 8 . In our patient, symptoms developed at the tenth hours, and after treatment, the symptoms improved fastly similar to the other cases in the literature.…”

Treatment with Vitis vinifera extract for controlling ascites and local swelling in snakebites

“…Therefore, pyridostigmine (Mestinon, Korean Drug, Seoul, South Korea) 180 mg per day (60 mg tablet three times daily) and VVse (Entelon, Hanlim Pharm, Seoul, South Korea) 300 mg per day (150 mg tablet twice daily) were administered to relieve the neurological symptoms and improve arm swelling, respectively. 7,8 The symptoms significantly improved on the third day following the snakebite. On the fifth day, the right arm swelling recovered to near normal, and the laboratory test results revealed no unusual findings (Table 1).…”

“…A skin allergy test for antivenom administration was positive, and the patient was deemed unsuitable for antivenom administration. Therefore, pyridostigmine (Mestinon, Korean Drug) 180 mg/day (60 mg tablet three times daily) and VVse (Entelon) 300 mg/day (150 mg tablet twice daily) were administered to relieve the neurological symptoms and improve arm swelling, respectively [ 7 , 8 ]. The symptoms significantly improved on the third day following the snakebite.…”