Managing snake bite patients – our experience from a tertiary care center of North East India

Abstract

Introduction: Snake bite is a common problem in North East India as most of the demography includes forests, cultivated land and tea gardens which are a natural habitat to various species of snakes. Snake bite comprises a significant number of hospitalizations with fatalities in this part of the country. We studied all the cases of snake bite poisoning that came to our hospital during the monsoon seasons in the department of medicine of a tertiary care hospital. Materials And Methods: All adult patients coming to the department of Emergency or out patients department in Assam Medical College and Hospital over a period of 1 year from July 2014 to June 2015 were include in our prospective observational study. A detailed clinical history was taken, local examination was done and all necessary laboratory examinations especially those related to bleeding and coagulation profile was done. Results And Observations: 116 patients were included in the study which included 70 (60.3%) male and 46 (39.7%) female patients, the male to female ratio being 1.52:1. Out of 116, 42 (36.2%) were poisonous snake bites and 74 (63.8%) were non poisonous. Out of the 42 cases of poisonous snake bites, 34 (80.9%) patients presented with hematologic symptoms, 8 (19.1%) patients had neurological symptoms and 4 (9.5%) patients expired during their hospital stay. Most common symptom was fright which was noted in 107 (92.2%) patients. This was followed by local swelling (78.4%), tingling and numbness (65.5%) and pain at the site of bite (58.6%). Only 9.5% patients reached tertiary care center within 4 hours of snake bite and majority (55.2%) were delayed by more than 12 hours. The whole blood clotting time, prothrombin time and INR was significantly high in patients with hematotoxic snake bite poisoning. Polyvalent Anti Snake venom (PASV) was administered in 22 (52.4%) cases out of 42 poisonous snake bite cases. 16 (47%) cases of hematotoxic snake bite and 6 (75%) cases of neurotoxic snake bite received PASV. 18 (52.9%) cases of hematotoxic snake bite received only fresh frozen plasma (FFP), 9 (26.5%) received FFP and PASV, 7 (20.6%) received only PASV. Two patients developed reaction to PASV which was managed successfully with adrenalin and steroids. Neostigmine was used in all 8 cases of neurotoxic snake bite poisoning. Conclusion: Though most of the snake bites were non poisonous, use of tourniquet and other alternative medicines caused morbidity. Hematotoxic snake bite was more common but was managed by use of polyvalent anti snake venom (PASV) and/or fresh frozen plasma. Neurotoxic snake poisoning were less common and managed by PASV and neostigmine. Two patient of hematotoxic snake bite died due to renal failure and two cases of neurotoxic snake bite died due to respiratory failure. Keyword : Snake bite poisoning, Polyvalent Anti Snake Venom, Hematotoxic snake, Neurotoxin snake