Autonomic Dysfunction Following Neurotoxic Snake Envenomation: Does Site of Bite Predispose?

South Asian subcontinent is among the highest burden areas in respect of snake bite. India is commonest place in this subcontinent with mortality following snake envenomation. The four most important venomous snakes in India are cobra (Naja naja) and common krait (Bungarus caeruleus), which are neurotoxic, and the saw-scaled viper (Echis carinatus) and Russell’s viper (Daboia russelii), which are hemotoxic1. Various autonomic dysfunction following neuro-paralytic envenomation with krait and cobra has been reported. Timely recognition and appropriate management of snake envenomation along with autonomic dysfunction helps to reduce morbidity and mortality.