title: Severe hypertension in elapid envenomation.
abstract: Snakebite is not an uncommon medical emergency in India; however, symptoms of autonomic dysfunction in snakebite are rare. The elapid snake envenomation is a frequent occurrence in India, and the krait bite is prevalent in the south Indian region. Here, we present three cases of snakebite with severe hypertension and requiring intravenous nitroglycerin (NTG). As the level of blood pressure (BP) decreased significantly following antisnake venom (ASV) injection in all three cases, it is likely that snake venom-induced dysautonomia might have contributed to severe hypertension in such patients. Clinical and therapeutic challenges of these cases are highlighted, so that practitioners coping with medical emergencies in resource-limited situations can consider snake (krait) bite in the differential diagnosis, and also manage effectively according to corroborative clinical evidences.
authors.affiliation: Department of Emergency and Critical Care Medicine, Sri Gokulam Hospitals and Research Institute, 3/60, Meyyanur Road, Salem, Tamil Nadu, India ; Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, Tamil Nadu, India ; Institute for Materials Research and Innovation, University of Bolton, Deane Street, Bolton BL3 5AB, United Kingdom.
authors.forename: Ramachandran
authors.initials: R
authors.lastname: Meenakshisundaram
authors.forename: Subramanian
authors.initials: S
authors.lastname: Senthilkumaran
authors.forename: Martin
authors.initials: M
authors.lastname: Grootveld
authors.forename: Ponniah
authors.initials: P
authors.lastname: Thirumalaikolundusubramanian
keywords: Elapid; Hypertension; Krait; Snakebite
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