How poison experts turned detective to save five-year-old's life

It sounds like an episode of the TV medical drama House‚ but it’s the real-life story of the battle to save a five-year-old’s life.

The boy’s ordeal began when he went for a midday walk with his grandfather through fynbos-covered dunes in Betty’s Bay in the Western Cape‚ says a report in the December edition of the South African Medical Journal.

He felt a sharp pain on his left foot‚ noticed a scratch‚ and limped home thinking he had stepped on a thorn‚ said Cherylynn Wium from Stellenbosch University medical school.

Within two hours he was vomiting‚ and had to be carried onto a 5pm flight to Johannesburg with his family because he was struggling to walk and keep his eyes open.

Unconscious and struggling to breathe‚ he was rushed to hospital in Johannesburg‚ where he was resuscitated and put on a ventilator‚ where he remained for five days. “He had prominent fixed dilated pupils and his left foot was slightly swollen‚” said Wium.

The boy‚ who is not named‚ had a CT scan and blood tests‚ and high levels of benzodiazepines were found in his serum and urine‚ leading doctors to suspect an overdose.

A benzodiazepine antidote was administered‚ but after six hours doctors concluded the psychoactive drug in his system came from pre-intubation medication.

A lumbar puncture and an MRI scan produced normal results‚ then 80ml of anti-venom was administered after a Cape cobra bite on the foot was suspected.

When the boy did not respond‚ the Tygerberg Poison Information Centre‚ where Wium works‚ was called in and diagnosed a bite on the foot by a berg adder‚ a 40cm snake whose venom affects cranial nerves and causes dilation of the pupil‚ droopy eyelids‚ loss of ability to focus the eyes‚ loss of the senses of smell and taste and facial paralysis.

Says the website African Reptiles and Venom: “Bites to children can also lead to the paralysis of the diaphragm which could lead to death. No recent deaths [have been] recorded for bites from this snake.”

There is no anti-venom for a berg adder bite but the boy recovered after treatment with saline solution. He recovered his sense of taste after a month but still had dilated pupils a year later.

Wium said the case highlighted the importance of contacting the Tygerberg poison information helpline (0861 555 777) promptly‚ especially when symptoms were mysterious.

“[It] illustrates that various ineffective and costly treatment modalities could have been avoided with simple symptomatic and supportive care.”

The berg adder is found in mountainous areas of the Western Cape‚ KwaZulu-Natal‚ Mpumalanga‚ and Limpopo. The Tygerberg poison centre has recorded 14 case of berg adder bits in the past 12 years.