Complex treatment of severe cobra venom poisoning with neurotoxic syndrome and hand necrosis: a clinical observation
Victor A. Matkevich,
Mikhail M. Potskhveriya,
Yuriy S. Goldfarb,
Sergey S. Petrikov,
Anastasia Yu. Simonova,
Galina N. Sukhodolova,
Tengiz T. Tkeshelashvili,
Dmitry A. Kisel,
Mikhail F. Bolonkin,
Maria V. Belova,
Maria V. Kareva,
Alyona G. Vorobyova,
Lola R. Asanova https://doi.org/10.47470/0869-7922-2026-34-2-140-149
EDN: pxjgpd
Abstract
Introduction. Snake bites, characterized by a highly neurotoxic venom, are a significant but underestimated public health problem. Such incidents pose a high risk due to the lack of registered specific antidotes in Russia and limited clinical experience in the treatment of such patients.
The objective of the study was to demonstrate an interdisciplinary approach to the management of a patient with severe poisoning due to a snake bite of the family Elapidae, complicated by the development of necrosis of the soft tissues of the hand, with a description of the stages of toxicological intensive therapy and reconstructive plastic interventions.
Clinical observation. Patient S., 28 years old, was admitted to the Department of Acute Poisoning Treatment at the N.V. Sklifosovsky Research Institute of Emergency Medicine 1.5 hours after the bite of a supposedly monocle cobra in the wrist area. At the prehospital stage, a tourniquet was applied independently, and the patient experienced nausea, vomiting, and speech disturbances. Upon admission to the intensive care unit, the patient exhibited swelling of the hand and lower third of the forearm, ptosis, respiratory and consciousness depression, leading to stupor, and cardiac conduction disorders. The patient was intubated and connected to an artificial lung ventilation device. Electrolyte disturbances, signs of a systemic inflammatory response and the myotoxic effect of the venom were detected. Antidote therapy was not performed. The complex treatment included intestinal lavage, two plasma exchange sessions with an interval of 24 hours, infusion, gastroprotective, antibacterial, nutritional and metabolic, symptomatic and vitamin therapy, prevention of thromboembolic and infectious complications. The patient’s clinical and laboratory parameters and vital functions were monitored. By day 6, the neurotoxic effect of the venom was stopped, and the patient was able to breathe independently. Due to the development of soft tissue necrosis in the bite area, necrectomy was performed within the healthy tissues, and the wound was drained. Subsequently, sanitary surgical interventions were performed. By the 14th day, the wound was cleaned and secondary sutures were applied. The total hospital stay was 16 days.
Conclusion. The presented clinical case of severe poisoning by asp snake venom, complicated by the development of extensive soft tissue necrosis, illustrates the need for an interdisciplinary approach at all stages of therapy, as well as constant monitoring of vital functions and laboratory parameters. The key areas of therapy included artificial ventilation to correct respiratory failure, administration of hormonal and antihistamine medications, intestinal lavage and plasma exchange, and timely involvement of surgeons to correct local complications.
Limitations. The described therapeutic approach is focused on the treatment of severe asp venom poisoning with a pronounced neurotoxic effect, complicated by soft tissue necrosis, and may be partially modified by bites from other snakes.
Compliance with ethical standards. The patient gave informed voluntary written consent to participate in the study and to publish her personal medical information in an anonymized form.
Аuthor’s сontribution. All co-authors contributed equally to the research and preparation of the article for publication.
Conflict of interest. The authors declare no apparent and potential conflicts of interest in relation to the publication of this article.
Funding. The study had no sponsorship.
Received: October 21, 2025 / Revised: January 15, 2025 / Accepted: March 27, 2026 / Published: April 30, 2026
About the Authors
Victor A. Matkevich
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department
Russian Federation
Russian Federation
Doctor of Medical Sciences, Scientific Consultant of the Department of Acute Poisonings and Somaticpsychiatric Disorders, N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, 129090, Russian Federation; Associate Professor, Department of Clinical Toxicology, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, 125993, Russian Federation; Leading Researcher at the Yu.M. Lopukhin Federal Scientific and Clinical Center for Physico-Chemical Medicine of the FMBA of Russia, Moscow, 119435, Russian Federation
e-mail: matkevich@mail.ru
Mikhail M. Potskhveriya
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Doctor of Medical Sciences, Chief of Department of Acute Poisonings and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, 129090, Russian Federation; Professor of the Department of Clinical Toxicology, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, 125993, Russian Federation
e-mail: potskhveriya@mail.ru
Yuriy S. Goldfarb
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Doctor of Medical Sciences, Professor, Head of the Department of External Scientific Relations, Leading Researcher of the Department of Acute Poisoning and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, 129090, Russian Federation; Professor of the Department of Clinical Toxicology, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, 125993, Russian Federation
e-mail: GoldfarbJS@sklif.mos.ru
Sergey S. Petrikov
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department
Russian Federation
Russian Federation
Doctor of Medical Sciences, Professor, Corresponding Member of the Russian Academy of Sciences, Director, N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, 129090, Russian Federation
e-mail: PetrikovSS@sklif.mos.ru
Anastasia Yu. Simonova
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department
Russian Federation
Russian Federation
Candidate of Medical Sciences, Leading Researcher of the Department of Acute Poisonings and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, 129090, Russian Federation; Acting Head of the Department of Clinical Toxicology, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, 125993, Russian Federation, Chief Clinical Toxicologist of the Moscow Health Department
e-mail: SimonovaAU@sklif.mos.ru
Galina N. Sukhodolova
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department
Russian Federation
Russian Federation
Doctor of Medical Sciences, Professor, Leading Researcher of the Department of Acute Poisonings and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute of Emergency Medicine, Moscow, 129090, Russian Federation
e-mail: sukhodol56@mail.ru
Tengiz T. Tkeshelashvili
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department
Russian Federation
Russian Federation
Junior Researcher of the Department of Acute Poisonings and Somatopsychiatric Disorders, Head of the Intensive Care Unit and Intensive Care Unit for Emergency Detoxification, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, Moscow, 120090, Russian Federation
e-mail: TkeshelashviliTT@sklif.mos.ru
Dmitry A. Kisel
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department
Russian Federation
Russian Federation
Plastic Surgeon, Research Scientist at the Department of Emergency Traumatology of the Musculoskeletal System, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, Moscow, 120090, Russian Federation
e-mail: dkis@yandex.ru
Mikhail F. Bolonkin
N.E. Bauman City Clinical Hospital No. 29
Russian Federation
Russian Federation
Anesthesiologist-intensive care specialist of the first category, Head of the Intensive Care Unit for Surgical Patients, N.E. Bauman City Clinical Hospital No. 29, Moscow, 111020, Russian Federation
e-mail: Oritbolonkin@gmail.com
Maria V. Belova
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Doctor of Biological Sciences, Associate Professor, Leading Researcher of the Department of Acute Poisonings and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, Moscow, 120090, Russian Federation; Associate Professor of the Department of Clinical Toxicology, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, 125993, Russian Federation; Professor of the Department Pharmaceutical and Toxicological Chemistry, I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Moscow, 119991, Russian Federation
e-mail: BelovaMV@sklif.mos.ru
Maria V. Kareva
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Candidate of Medical Sciences, Senior Researcher at the Department of Acute Poisonings and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, Moscow, 120090, Russian Federation; Assistant of the Department of Clinical Toxicology, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, 125993, Russian Federation
e-mail: KarevaMV@sklif.mos.ru
Alyona G. Vorobyova
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department
Russian Federation
Russian Federation
Researcher at the Department of Acute Poisonings and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, Moscow, 120090, Russian Federation
e-mail: VorobevaAG@sklif.mos.ru
Lola R. Asanova
N.V. Sklifosovsky Research Institute of Emergency Medicine of the Moscow City Health Department; Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Junior Researcher at the Department of Acute Poisonings and Somatopsychiatric Disorders, N.V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Health Department, Moscow, 120090, Russian Federation; Assistant of the Department of Clinical Toxicology, Russian Medical Academy of Continuous Professional Education of the Ministry of Health of the Russian Federation, Moscow, 125993, Russian Federation
e-mail: AsanovaLR@sklif.mos.ru
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For citations:
Matkevich V.A., Potskhveriya M.M., Goldfarb Yu.S., Petrikov S.S., Simonova A.Yu., Sukhodolova G.N., Tkeshelashvili T.T., Kisel D.A., Bolonkin M.F., Belova M.V., Kareva M.V., Vorobyova A.G., Asanova L.R. Complex treatment of severe cobra venom poisoning with neurotoxic syndrome and hand necrosis: a clinical observation. Toxicological Review. 2026;34(2):140-149. (In Russ.) https://doi.org/10.47470/0869-7922-2026-34-2-140-149. EDN: pxjgpd
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