rapid progressive course of naja naja oxianabitten patient

Cases of snakebites especially with an elapidae are considered as a medical emergency. however, in some cases of elapidae envenomation, bite signs might be unpredictable.case: dorsal surface of the second finger of a 39-year-old man was bitten by n. naja oxiana less than half hour before his admission. on arrival, patient had clear bilateral ptosis, mydriasis, reduced light reflex of pupils and sialorrhea. other muscles power had no problem. the patient was agitated due to suffocation secondary to respiratory muscle paralysis, during half hours of hospitalization. he was intubated and mechanically ventilated. he was treated by antivenom, 10 vials as attack dose, 5 vials as repeated dose that was repeated three times and 2 vials every 8 hours as maintenance dose. he received antibiotic for local superinfection. although, he did not receive any acetylcholinesterase inhibitors, he was extubated 48 hours later. the patient was discharged on the 7th day in good general condition with oral antibiotic prescription and no complication except local cellulitis. in conclusion, for efficient treatment of patients bitten with elapidae, we need to find the best course of treatment using the adequate antivenom as fast as possible.