Acute Severe Anaphylaxis in Nepali Patients with Neurotoxic Snakebite Envenoming Treated with the VINS Polyvalent Antivenom

Box 1

Signs of neurotoxicity. One point is given for each feature present to calculate the neurotoxicity score. : defined as < 3 on the MRC scale, : clinical indications for mechanical ventilation.

Inability to frown

Inability to retract upper eyelids on looking up

(bilateral ptosis)

Inability to protrude the tongue beyond incisors

Broken neck sign

Inability to swallow

Inability to open the mouth

Skeletal muscle weakness

Gag reflex loss

Paradoxical breathing