A fisherman handling nets is bitten on the finger by a sea snake. He reaches shore 2 hours later complaining of severe generalised muscle pain, stiffness of the neck and jaw, and weakness of the legs. His urine is dark brown. Apart from neurotoxicity, the complication that most threatens his life is:

• A Disseminated intravascular coagulation with spontaneous bleeding
• B Ascending flaccid paralysis with respiratory failure
• C Massive intravascular haemolysis with anaemia
• D Rhabdomyolysis leading to hyperkalaemia and acute renal failure ✓

Explanation

Sea snake venom is distinctive among elapids in being strongly myotoxic: it damages skeletal muscle, releasing myoglobin (dark brown urine), creatine kinase and potassium. Death results from hyperkalaemic cardiac arrhythmia or acute tubular necrosis from myoglobinuria, hence the importance of monitoring serum potassium. DIC is a viper feature, primary intravascular haemolysis is not typical, and although mild neurotoxicity occurs, respiratory failure from paralysis is less dominant than the myotoxic syndrome.

Reference: Parikh's Textbook of Medical Jurisprudence and Toxicology, 8th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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