Neuroparalytic snakebite resulting in cerebral salt wasting and refractory hyponatremia: A case report

Neuroparalytic snake bite presents commonly as early morning neuroparalytic syndrome with ptosis, ophthalmoplegia and respiratory muscle paralysis. However, there are multiple lesser-known constituents of the snake venom that can cause other life-threatening complications, including persistent mydriasis, alterations in blood pressure, hyponatremia, and rhabdomyolysis. Venom-derived natriuretic peptides can produce significant hyponatremia due to urinary wasting. We report a 14-year-old girl who presented with EMNPS and subsequently developed persistent profound hyponatremia, found to be due to excess urinary sodium losses, that responded well to fluid management including administration of hypertonic saline.