BRAIN DEATH CRITERIA

Snake bite is an important cause of mortality and morbidity. It is estimated that each year snake bite is responsible for 30,000 to 40,000 deaths world wide1. Most snake bites are innocuous and are delivered by non poisonous species. There are 15% of the more than 3000 species of snakes, which are considered dangerous to humans2. The family Viperidae (Pit vipers) is the largest family of venomous snakes. The sub-family Crotalidae (Pit vipers) is also very common in certain parts of the world and includes rattle snakes, cotton mouths (Agkistrodon) and copper heads (Agkistrodon). Elapidae includes the coral snakes. Ophiophagus Hannah (King Cobra) elapidae (kraits and Cobras), Viperidae (Pitless vipers), crotalidae (pit vipers) are indigenous snakes of Pakistan3. Venom is produced by paired glands below the eye. The venom dosage per bite depends on the laps of time since the last bite, and the degree of threat the snake feels.The nostril pits respond to the heat emission of the prey. Venom is most by water and enzymatic proteins like proteases, collagenase and arginine ester hydrolase and hyaluronidase which promotes spread of venom by tissue destruction4. Coral snakes produce potent neurotoxins that later causes respiratory failure from typical systemic neuromuscular blockade. Myonecrosis raises concerns about myogloinuria and renal damage. In clinical practice the snake bite patient either present as haemotoxic or with neurotoxic manifestation. King cobra (Ophiophagus), India cobra (Naja Naja) and brown cobra (Naja Oxiana) produce predominately neurotoxic symptoms. We hereby report a case of cobra snake bite which totally paralyzed the patient for twenty six days. He recovered defying all the clinical brain death criteria5.