Attached
Introduction: Most of the snake bite deaths reported were due to delay in giving antivenom or non-availability of
species specific antivenom and the relatives of deceased allege against doctors that proper care is not given. Forensic
pathologist is expected not only to give cause of death but also give opinions about potential negligence in such
cases. Case report: A middle aged woman died while being transported from a local hospital to a tertiary care
hospital following a snake bite. She was brought to the hospital with symptoms suggestive of neurotoxin poisoning
and anti-snake venom was given at the local hospital. The patient developed shortness of breath and she was
transferred to a tertiary-care hospital for further ventilator support, but the patient was pronounced dead on the way
after 2 hours of the bite. Bite mark with two fangs was found on left upper part of the breast. Inflammatory signs
were found around the bite mark with necrosis and blister formation. Autopsy revealed no hematological
manifestations. Conclusions: The COD was envenomation of neurotoxin due to cobra bite. The allegation of
medical negligence may be challenged, because death could occur rapidly within 30 minutes to two hours in cobra
bites and delay in transport may also have played a vital role especially being a rural area. Role of non-availability
of species specific antivenom and efficacy of common anti snake venom should be further studied before giving
opinions regarding potential negligence.
