Sharma Milap, Kalia Shaurya, Sharma Seema
Department of Pediatrics, DRPGMC, Kangra, H.P., India.
J Forensic Leg Med. 2016 Aug;42:79-81. doi: 10.1016/j.jflm.2016.05.002. Epub 2016 May 24.
An 11 year old boy presented with pain abdomen and tenderness all over body when he got up from sleep early in the morning and subsequently had one vomiting after 30 min. He had no other significant past medical history. The child was shifted to nearby health facility where he was managed as a case of acute abdomen on the basis of suggestive history and clinical findings. Within 2 h after the onset of clinical features suggestive of acute abdomen the patient went on to develop marked ptosis and flaccid quadriplegia. The young boy underwent a sequence of clinical tests which were noncontributory. Based on the clinical picture, a differential diagnosis of hypokalemic paralysis, botulism, Miller Fischer syndrome and EMNS were considered. Through exclusion, the most probable diagnosis for the symptoms was elapid envenomation hence he was started on anti-snake venom (ASV) with working diagnosis of EMNS. Within 2 h, he began to show improvement. This recovery with ASV suggests the possibility of elapid envenomation.
一名11岁男孩清晨起床时出现腹痛和全身压痛，30分钟后呕吐一次。他既往无其他重大病史。该患儿被转至附近的医疗机构，根据提示性病史和临床检查结果，按急腹症进行处理。在出现提示急腹症的临床症状后2小时内，患者继而出现明显的上睑下垂和弛缓性四肢瘫。该小男孩接受了一系列临床检查，但均无诊断意义。根据临床表现，考虑鉴别诊断为低钾性麻痹、肉毒中毒、米勒·费希尔综合征和埃姆斯利-米尔斯综合征（EMNS）。通过排除，这些症状最可能的诊断是眼镜蛇科蛇咬伤中毒，因此他开始接受抗蛇毒血清（ASV）治疗，初步诊断为EMNS。2小时内，他开始出现好转。使用ASV后的这种恢复提示了眼镜蛇科蛇咬伤中毒的可能性。
