Short communicationWhat kills everyone, gives a high for some—Recreational Snake Envenomation
Introduction
Snakes occupy a prominent position in mythology, folklore and popular culture throughout the world. (Morgan, 2008) Unfortunately, snakebite is a painful reality in South Asia with high mortality and unmet need for treatment. (Williams et al., 2010) India has the highest number of deaths in the world due to snake bites. (Kasturiratne et al., 2008) It is ironic in this context that there are multiple reports of intentional exposure to snake venom for recreation. (Gowda et al., 2014, Katshu et al., 2011, Krishnamurthy and Braganza, 2013, Pradhan et al., 1990, Senthilkumaran et al., 2013) All the reported cases have described euphoria, relaxation and other psychotropic effects but no tissue necrosis, respiratory distress or neurological deficits. These reports have concluded that offending snake could belong to Elapidae family (Indian Cobra and Indian Krait) as they are widely found in Indian sub-continent and have predominantly neurotoxic venom. An interesting paradox here is that case fatality of Cobra and Krait envenomation in South Asia is 77% –100% without treatment. (Ahuja and Singh, 1954, Kularatne et al., 2009) There is no certainty on this matter because the offending snake was not directly identified.
We attempt to understand this phenomenon through two competing hypotheses. The first hypothesis is that these cases are of neurotoxic envenomation and observed effects are due to biological effects of the same. The second hypothesis is that a combination of psychological processes explains the observed effects better than acute effects of a neurotoxic venom. We report a case of repeated intentional exposure to snake venom wherein, the identity of snake was directly established.
Section snippets
Case presentation
A 21-year-old male presented to a tertiary care centre in Southern part of India. He was hospitalised and evaluated by addiction medicine specialists. We gathered information from him and his parents during multiple interviews. Patient and his parents gave a history of hyperactivity, distractibility, impulsivity, oppositional behaviour since an age of nine years. These problems caused significant impairment in his education, family relationships and he had changed several jobs in the last three
Discussion
We report a case of a young boy with high impulsivity, sensation seeking and multiple SUD s, who exposed himself to cobra bites on multiple occasions. It was a matter of dismay for us that he survived multiple cobra envenomations. An easy answer to this mystery is a phenomenon called ‘dry bite’. In such cases, no venom is injected in the body but fang-marks are present. A study from India reports a high incidence (66%) of dry-bite. (Suchithra et al., 2008) He also had neurological symptoms of
Funding
None.
Acknowledgement
None.
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