Abstract
Snakebites can present local or systemic envenomation, while neurotoxicity and respiratory paralysis are the main cause of death. The mainstay of management is anti-snake venom (ASV), which is highly effective, but liable to cause severe adverse reactions including anaphylaxis. The types of adverse reaction to polyvalent anti-snake venom have not been previously studied in Bangladesh. In this prospective observational study carried out between 1999 and 2001, in the Snake Bite Study Clinic of Chittagong Medical College Hospital, 35 neurotoxic-snake-bite patients who had received polyvalent anti-snake venom were included while the ones sensitized to different antitoxins and suffering from atopy were excluded. The common neurotoxic features were ptosis (100%), external ophthalmoplegia (94.2%), dysphagia (77.1%), dysphonia (68.5%) and broken neck sign (80%). The percentage of anti-snake venom reaction cases was 88.57%; pyrogenic reaction was 80.64%; and anaphylaxis was 64.51%. The common features of anaphylaxis were urticaria (80%); vomiting and wheezing (40%); and angioedema (10%). The anti-snake venom reaction was treated mainly with adrenaline for anaphylaxis and paracetamol suppository in pyrogenic reactions. The average recovery time was 4.5 hours. Due to the danger of reactions the anti-snake venom should not be withheld from a snakebite victim when indicated and appropriate guidelines should be followed for its administration.
Highlights
IntroductionThe wellspring of venomous bite management is anti-snake venom (15), a protein product, liable to cause adverse reaction that may be immediate or delayed
Snakebite is an important occupational health hazard which may lead to death in rural areas of many tropical countries including Bangladesh
Due to the danger of reactions the anti-snake venom should not be withheld from a snakebite victim when indicated and appropriate guidelines should be followed for its administration
Summary
The wellspring of venomous bite management is anti-snake venom (15), a protein product, liable to cause adverse reaction that may be immediate or delayed. Antivenoms may be withheld by physicians despite their clear indication due to the belief that they are more dangerous than the disease. This idea remains a vestige of an earlier epoch, when antivenoms were very crude and many patients had been previously sensitized by the use of other antisera. The acute adverse reaction to anti-snake venom, which includes severe anaphylaxis and is commonly followed by pyrogenic reaction, has been a point of concern to several physicians (13). The severity of a venomous bite is more dangerous than the antivenom if it remains untreated while active management of venomous snakebites through proper guidelines should be practiced without fear
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