Administration Of Anti-snake Venom Research Articles

Acute Ischemic Stroke After Russell’s Viper Snake Bite, Rare Presentation: A Case Report

Snake bitesare a global health hazard and are a noteworthy cause of mortality and morbidity especially in Southeast Asia. Cerebral complicationsafter snake bite are rare. It can be attributed to various factors such as vasculitis, vasospasm, endothelial damage; toxin-induced procoagulant effect, and disseminated intravascular coagulation. We present a case of a previously healthy 22-year-old woman who suffered acute multiple cerebral infarctions following Russell's viper bite. Imaging revealed significant non-hemorrhagic infarctions in the left middle cerebral artery territory and right pons, indicating rare yet severe neurological complications of viper envenomation. The patient experienced serious complications including rhabdomyolysis and acute kidney injury, ultimately leading to her demise due to aspiration pneumonia and septic shock. This case underscores the potential neurological impact of viper envenomation and underscores the challenges in managing delayed procoagulant effects of snake venom, despite the administration of anti-snake venom. Early detection and intervention remain vital in addressing such devastating outcomes.

Snakebites in Three Districts of Rural Areas of Western India during Winter

Abstract Introduction: Snakebite is more of a seasonal problem in the state of Rajasthan, as is so in India. The peak incidence of snakebite occurs in the monsoons, with high frequency also reported during the harvest season. The estimated incidence of snakebite in India is 2–3 million, annually leading to 58,000 deaths. Rajasthan is the largest state by area in India and is one of the states that report a high incidence of death due to venomous snakebite in the One-million Death Study. Since snakebite is largely seen as a seasonal problem mainly concentrated in the rainy and summer seasons, the aim of the study was to assess the incidence and mortality of snakebites in winter. Materials and Methods: A telephonic survey of the snakebites in the rural areas of three selected districts of Rajasthan, Western India, chosen based on climatic and geographic conditions. Calls were made to medical officers/in-charge of different primary care centers (PHC)/community health centers (CHC) to report snakebites in the winter season. Medical officers in PHCs/CHCs were asked to report the number of cases reported, deaths, anti-snake venom (ASV) administration, and serious adverse reactions related to ASV administration. The medical officers were further asked if they were confident while administering ASV or not. Results: A total of two deaths were reported out of 39 snakebites (5.1%). ASV was administered to the majority of them (94.8%) with two of them showing adverse reactions to ASV (5.1%). Majority of the bites were reported from primary health centers. Conclusions: The present study suggests that snakebite is not a seasonal problem with significant cases occurring even during the winter months. The study highlights the need for creating awareness and taking adequate precautions among vulnerable population, even in the winter season. In addition, sentinel surveillance for snakebites could be strengthened at the district level.

Pemberian SABU (Serum Anti-Bisa Ular) untuk Kasus Gigitan Ular Awitan Lama dengan Komplikasi Disseminated Intravascular Coagulation (DIC)

Background: Snakebite is a neglected disease in subtropical and tropical countries in Asia, Africa, and Latin America. Snakebite is one of the most common venomous animal bites in the world. Case: A 34-year-old male presented with a history of snakebite two days before with a swollen left gluteus and spontaneous gum bleeding. At the emergency room, the patient was fully conscious with blood pressure of 120/80 mmHg, temperature of 36.8oC, pulse rate of 80 beats per minute, and respiration rate of 18 times per minute. Blood studies showed prolonged prothrombin time (PT) and activated partial thromboplastin time (aPTT), leucocytosis, thrombocytopenia, low hemoglobin, and elevated renal function test. The patient's condition was improved after administration of anti-snake venom, vitamin K injection, transfusion of fresh frozen plasma and packed red cells. He was discharged after three days of hospital stays. Conclusion: Antivenom is the only specific antidote to snake venom; in Indonesia, there is only one local antivenom, commonly known as SABU (serum anti-bisa ular). Inappropriate use of antivenom should be strongly discouraged. Administration of the antivenom should be accompanied by preparedness for anaphylaxis risk.

Clinical, laboratory profile and outcomes in children with snakebite from Eastern India.

Snakebite remains a significant public health problem worldwide, particularly in rural areas with unexpected morbidity and mortality. This study evaluated the clinical, laboratory profile and outcomes in children with snake bites from Eastern India. This was a retrospective case record-based study between January 2017 and December 2021. The clinical features, complications, laboratory profiles and outcomes were analysed. Thirty children with snake bites were admitted during this study period. There was a male predominance with a ratio of 2.3:1. The mean age of presentation was 10.4 years. About 60% of bites occurred during the rainy season between July and September. Most bites (96%) were on lower limbs, predominantly showing vasculotoxic features followed by neurotoxic and a combined presentation. In this study, around 53% received anti-snake venom (ASV) before reaching our centre; the median time to reach our centre was 13 h. Complications such as acute kidney injury (AKI), cellulitis, shock and coagulation abnormalities were common in those who arrived early (before 6 h) than in those who reached late (after 6 h). Similarly, the mean duration of hospital stay was less for those seeking medical attention early as compared to those reaching late for treatment (4.7 days vs. 7.2 days). Twenty-six out of 30 (86.7%) were discharged without any sequelae, 3 (10%) children were left against medical advice and one died. Snakebite remains a major health problem in children causing significant morbidity and mortality. Children, in general, especially males, are particularly vulnerable because of their playful and explorative nature and considerable time spent in outdoor activities. Preventive measures, education about avoiding traditional first aid methods and early administration of ASV reduce complications, duration of hospital stay and avoid the use of antibiotics.

PRE-TREATMENT WITH LOW DOSE SUBCUTANEOUS ADRENALINE TO PREVENT ADVERSE REACTIONS TO ANTI SNAKE VENOM FOLLOWING SNAKE BITE

Aim and objective : To assess the efcacy of low dose subcutaneous adrenaline to prevent adverse reactions to Anti Snake Venom (ASV) in hospitalised patients following snake bite. Hospital Methods : ised patients following snake bite requiring ASV were randomised to receive either 0.25ml 1:1000 dilutions adrenaline subcutaneously or placebo as pre-treatment before ASV administration. Pregnants, age less than 12 years and more than 70 years, patients who received ASV in the past, history of adverse reactions to adrenaline, patients with obstructive airway disease, ischemic heart disease, stroke and patients who received ASV before hospital admission were excluded from the study. Results : 50 patients were included in the study. 26 patients received low dose subcutaneous adrenaline and 24 patients received placebo. 3 patients(11%) in adrenaline group and 13 patients(54%) in placebo group developed adverse reactions following ASV administration. Conclusion : 0.25ml 1:1000 dilutions subcutaneous adrenaline given immediately before ASV administration reduces incidence of adverse reactions to ASV

Neuroparalytic Snake Bite Masquerading as Acute Abdominal Pain in Children

Background: Neurotoxic snakebite (usually by the krait) presents with abdominal colic and chest pain as a common premonitory sign of envenomation. Being a nocturnal snake, the time of unprovoked painless biting is usually at night and the victims are individuals sleeping on the ground. Thus, history is usually not forthcoming. Snakebite causes morbidity (neuroparalytic, myopathic, vasculopathic, venom-induced consumption coagulopathy, cardiotoxic, nephrotoxic, etc.), and mortality if not given timely treatment with anti-snake venom (ASV), the only specific treatment. Clinical Description: We present four children from a rural background who were admitted successively over a month during the last rainy season. They initially became symptomatic with acute abdominal pain from midnight to early morning time and developed neuroparalytic manifestations within a few hours. On exclusion of other causes by clinical evaluation, we suspected snakebite envenomation though there was no witnessing of the event or evidence of fang bites. Investigations to rule out commonly associated organ dysfunction were ordered. Management: All children were given supportive therapy. Three cases required mechanical ventilation. The first two received ASV relatively late as the suspicion of snakebite was not considered initially. In the third case, the administration of ASV was early and the hospital stay was shorter. The fourth case received ASV at a peripheral health center and was referred in case he required ventilator support. However, his neuroparalysis did not progress to respiratory failure and he was discharged the earliest. Conclusions: Clinicians should consider snakebite in children belonging to rural areas who present with acute abdominal pain during the rainy season, and monitor for signs of neurotoxicity and other clinical manifestations of snake envenomation. A high index of suspicion should be kept, as definitive treatment with ASV results in early recovery without any sequelae, and reduces mortality.

A Study of Clinical Profile of Patients with Snake Bite Attending a Tertiary Care Hospital in the North Bank of the Brahmaputra

Background: Snake bite envenomation is a neglected tropical disease which needs urgent medical attention and anti-snake venom (ASV) infusion but is often overlooked and under-reported owing to the age-old tradition of local aid by quacks, poor transportation facilities, and lack of public awareness. This leads to delays in hospitalization and causes increased morbidity and mortality. WHO’s global target is to reduce the number of snake bite deaths to half by 2030 and India needs to play an important role in achieving the target. Aims and Objectives: (a) To study the clinical profile of patients, 12 years of age or above, presenting with snake bites, attending OPD and Emergency in the Department of Medicine, TMCH. (b) To study the effectiveness of ASV and adverse effects following its use. Materials and Methods: (a) Study design—hospital based cross-sectional study. (b) Duration—1st January 2020 to 30th June 2022. (c) Number of cases—221. Results: Out of 221 cases, non-venomous bites and venomous bites were 88.2% and 11.7%, respectively. Out of the venomous cases, 61.5% were hemotoxic and 38.4% were neurotoxic. A total of three patients died during our study and all of these were from neurotoxic bites. Conclusion: Snake bite is an important rural and occupational hazard. Delay in hospitalization following snake bite creates a hindrance in timely administration of ASV leading to deleterious effects which may prove fatal. In the present study neurotoxic bites proved to be more fatal in comparison to hemotoxic bites.

Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases.

Snakebites are a common cause of morbidity and mortality, especially in tropical countries. Snakebites in any community are managed based on the clinical features and intravenous administration of antisnake venom (ASV). The administration of ASV is either deficient or given in excess based on clinical decisions and whole blood clotting test results. The present study is designed to analyze the level of snake venom component in the blood of snakebite in association with the clinical features. Blood samples were collected from the patients admitted to Karnataka Institute of Medical (KIMS) hospital with a history of snakebite considering the inclusion criteria. Serum was collected from the blood of snakebite patients before and after ASV and used to assess the level of venom-specific phospholipase A2 (PLA2) enzyme using the enzyme-linked immunosorbent assay (ELISA) method. Quantitative ELISA results revealed that the snake venom-specific PLA2 in the victim's blood was in the range of 0.3-1.27 mg/mL before the administration of ASV. However, the concentration of PLA2 after 24 hours of ASV administration was decreased in most of the patients. Further, it was observed that envenomation complications were directly proportional to the amount of snake venom-specific PLA2 found in the blood of the snakebite patient. The study concludes that snake venom-specific PLA2 in the blood of snakebite patients could be used as a reliable venom marker, which helps in determination of appropriate ASV dosage in snakebite patients. Kaulgud RS, Hasan T, Vanti GL, Veeresh S, Uppar AP, Kurjogi MM. Snake Venom-specific Phospholipase A2: A Diagnostic Marker for the Management of Snakebite Cases. Indian J Crit Care Med 2022;26(12):1259-1266.

Bite-to-needle Time - An Extrapolative Indicator of Repercussion in Patients with Snakebite.

Snakebite is a significant occupational and environmental hazard in tropical countries. The treatment of snakebite includes care of the wound, supportive care, and administration of anti-snake venom (ASV). Time is crucial to reducing the morbidity and mortality of patients. This study aimed to assess the "bite-to-needle time" with morbidity and mortality of snakebites and correlate it. A total of 100 patients were included. Detailed history included the time since snakebite, bite site, species of snake, and symptoms at presentation, which included level of consciousness, cellulitis, ptosis, respiratory failure, oliguria, and bleeding manifestations. "Bite-to-needle time" was noted. Polyvalent ASV was administered in all patients. Duration of hospitalization and complications, including mortality were noted. The age-group of the study population was 20-60 years. About 68% were males. Krait was the commonest species (40%), and the lower limb was the commonest bite site. Within 6 hours, 36% of patients received ASV, and between 6 and 12 hours, 30%. Patients with a bite-to-needle time of under 6 hours spent less time in the hospital and experienced fewer complications. Patients with bite-to-needle times longer than 24 hours had more ASV vials, complications, hospital-stay length, and death. An increase in bite-to-needle time increases the chances of systemic envenomation, hence, the severity of complications or morbidity and risk of mortality increases. The necessity of timing and the value of administering ASV on time must be emphasized to the patients. Jayaraman T, Dhanasinghu R, Kuppusamy S, Gaur A, Sakthivadivel V. Bite-to-needle Time - An Extrapolative Indicator of Repercussion in Patients with Snakebite. Indian J Crit Care Med 2022;26(11):1175-1178.

Evaluation of Risk Factors of Snake Envenomation and Associated Complications Presenting to Two Emergency Departments in Oman.

ObjectivesTo assess the risk factors of snake envenomation and the associated complications that patients present with, using data from two different emergency departments in Oman. The secondary aim was to describe the common characteristics of the presenting patients.MethodsThis multicenter retrospective observational study reviewed all cases presenting with symptoms of snakebite to the emergency departments of Sultan Qaboos University Hospital (tertiary) from March 2016 until August 2017 and Rustaq Hospital (secondary) from August 2015 to August 2017.ResultsA total of 212 cases met the inclusion criteria. Coagulopathy was observed in 82 (38.7%) patients, while 14 (6.6%) had acute kidney injury (AKI) and 5 (2.4%) had external bleeding. Of the patients who developed AKI, 85.7% (p < 0.001) had encountered the snake in a valley and initially had bleeding from the site of the bite (p < 0.001) and vomiting (p < 0.007). The delay in receiving the anti-snake venom (ASV) increased the risk of AKI (p < 0.016). Of the patients who developed coagulopathy, 47.6% (p < 0.001) had encountered the snake on a farm and 72.0% (p < 0.002) received the bite to a lower limb. Increased time from bite to ASV was associated with development of coagulopathy (p < 0.001). No patient death was recorded.ConclusionsThe location (terrain) where the snake was encountered was associated with the patient’s risk for either AKI or coagulopathy, which suggests the preference of different snake species to different types of habitat. The time elapsed between the bite and the ASV administration was associated with higher risk of development of AKI or coagulopathy.

The study of coagulation profile in relation to anti snake venom administration among patients with snake bite in a tertiary care hospital

The study of coagulation profile in relation to anti snake venom administration among patients with snake bite in a tertiary care hospital

Retrospective Hospital-Based Cohort Study on Risk Factors of Poor Outcome in Pediatric Snake Envenomation.

Among Southeast Asian countries, India has reported the highest mortality due to snakebite envenomation. To identify the risk factors of poor outcome (mortality/mechanical ventilation/renal replacement therapy-RRT) in pediatricsnakebite envenomation. Case records of children aged less than 13 years withsnakebite envenomation admitted between June2009 and July 2015 were reviewed retrospectively. Medical records of the patient died within 6 h, those required RRT before administration of antisnake venom (ASV), and those with unknown bites were excluded. A total of 308 patients were included. One hundred eighty (58.4%) had hemotoxic, and 128 (41.6%) had neuroparalytic envenomation. Median (interquartile range) bite to ASV time was 3 (2-6) h. Seventy-five (24.4%) patients received ASV within 6 h of bite. Poor outcomes occurred in 128 (41.6%), and 36 (11.7%) patients died. On binary logistic analysis (adjusted odds ratio, 95% confidence interval), age ≤5 years (2.97, 1.28-6.90), walking (6.15, 2.88-13.17), playing (3.36, 1.64-6.88), no tourniquet (2.39, 1.25-4.57), time to ASV more than 6 h (2.71, 1.45-5.06), fang marks (2.22, 1.21-4.07), neurotoxic envenomation (3.01, 1.11-8.13) and additional ASV dose (8.41, 2.99-23.60) were independently predicted the poor outcome (Hosmer and Lemeshow goodness of fit model p = 0.135; overall percentage of the model is 72.2% and R-square = 0.28). Age below 5 years, activity at/after the bite (playing/walking), no tourniquet, a longer bite to ASV time, presence of fang marks, neurotoxic envenomation and need for additional ASV dose were independent predictors of poor outcome in pediatricsnakebite envenomation.

Snakebites in Suriname: Evaluation of the Protocolled Administration of Anti-Snake Venom in a Tertiary Care Setting.

Venomous snakebites regularly occur in Suriname, a middle-income country located on the north coast of South America. Officially reported data on incidence and mortality are lacking. The aim of this retrospective study was to assess whether the use of our national snakebite protocol with selective administration of anti-snake venom (ASV) in patients with signs of snakebite envenoming improved clinical outcome as measured by mortality and length of stay (LOS) in the hospital. Medical records of all patients admitted at the Academic Hospital Paramaribo from 2013 to 2015, before and after the introduction of the protocol, with signs of snakebite envenoming, were reviewed for demographics, snakebite characteristics, mortality, length of hospital stay, administration of ASV, and occurrence of complications. Secondary outcome measures were the development of late complications due to a snakebite. Sixty-eight and 76 patients in 2013 and 2015, respectively, with venomous or potentially venomous snakebites were identified. One patient (1.5%) in 2013 and 29 patients (38.2%) in 2015 received ASV. In 2013 one patient died: deterioration of renal function occurred before protocolled ASV administration. No deaths were reported in 2015. There was no difference in the overall length of hospital stay between 2013 and 2015 or in the total number of late complications. In 2015, the mean LOS (±SD) for patients who did not receive ASV (n = 47) was significantly lower than that for patients who received ASV (n = 29), 2.15 ± 2.27 versus 5.31 ± 5.53 days, respectively (P = 0.001). The mean LOS (±SD) for patients who did not receive ASV in 2013 (n = 67) and 2015 (n = 47) was 4.06 ± 5.44 and 2.15 ± 2.27 days, respectively, which also differed significantly (P = 0.025). The protocolled evaluation of snakebite victims resulted in more patients being admitted to the intensive care unit and receiving ASV and a shorter length of hospital stay for the patients who did not receive ASV, and no difference in the occurrence of complications was observed in Suriname's largest hospital responsible for the acute care of snakebite victims.

Factors associated with treatment outcomes in anti-snake venom (ASV) administered snakebite patients

Introduction: Snakebite is a neglected tropical disease causing many deaths and serious consequences in Asia and Africa. Anti-snake Venom (ASV) is effective to prevent or reverse the venomous effects of snakebites. The aim of this study was to identify the prevalence of venomous snakebites and factors associated with treatment outcomes in a district hospital of Western Terai in Nepal.&#x0D; Method: A single health facility-based retrospective cross-sectional study was conducted with collection of information from the record section of Bhim Hospital, Rupandehi, Nepal. All snakebite cases treated during July 2013 to July 2018 were included. The data on prevalence of snakebite and treatment outcomes were analyzed. Fischer’s exact test and exact logistic regression were performed to identify factors associated with treatment outcomes of venomous snakebites.&#x0D; Result: The prevalence of venomous snakebites was 3.71% (163/4399). Among cases with complete information (N=120), two-third were cured, and one-fourth were referred. Median number of ASV vials used was 12. Age and ASV vials used showed significant positive moderate correlation (r=0.38, p-value&lt;0.001). Year of treatment showed significant association with treatment outcomes. In multivariate analysis, though insignificant, higher adjusted odds of cure was present with one unit increase in ASV vial (AOR= 1.16) and when the bite was in extremities (upper extremities AOR = 11.46 and lower extremities AOR= 21.68).&#x0D; Conclusion: Snakebite cases require urgent management with administration of ASV, and proper recording of the cases in order to provide tangible evidence for policy and guideline formulation.

A STUDY ON CLINICAL PROFILE AND OUTCOME OF SNAKE ENVENOMATION IN CHILDREN AT TERTIARY CARE HOSPITAL JHALAWAR, RAJASTHAN

Background: Snake bite is generally considered to be a rural problem and has been linked with environmental and occupational condition is a neglected public health problem.&#x0D; Method: This study was conducted in children admitted with snake bite in Pediatric Intensive Care Unit in the year 2019. Their demographic details, site of bite, arrival time, 20Minutes Whole Blood Clotting time, clinical signs and symptoms, complications and outcome were measured.&#x0D; Results: The male: female ratio was 1.33:1. Peak age group affected was 6 to 12 years old children. Lower limbs were commonly bitten. 88.1% of children arrived in the hospital between 0 and 6 hours after the bite. Pain and swelling at the site of bite were the most common symptom of envenomation. There were only two deaths during the study period. Conclusion: Snake bite is a life threatening emergency. Identification, timely diagnosis and early administration of anti-snake venom will certainly aid to curb mortality in snake bite.

Snake bite, a neglected menace: a prospective observational study in a tertiary care pediatric intensive care unit

Background: Snake bite is a neglected and underestimated public health problem in tropical and subtropical region. Snake envenomation is a well-known cause of morbidity and mortality in India. In 2009, WHO declared snake bite a neglected disease. Ophitoxaemia is an exotic term characterising the clinical spectrum of snake bite. Objective of this study was to know the outcome in paediatric snake bite cases in a tertiary care PICU (Paediatric Intensive Care Unit) with special reference to envenomation time and also to evaluate and analyse few atypical presentations of snake envenomation by proper history taking, physical examination and help start early intervention to prevent morbidity and mortality.Methods: A prospective observational study was done in Paediatric Intensive care unit of the hospital from June 2017 to June 2019.Results: Around 56.8% of 109 cases were non-poisonous snake-bites. Out of 47 cases admitted to PICU, 68.08% developed cellulitis at the site of bite with Staphylococcus aureus being the commonest organism isolated (56.25%). Anaerobes (bacteroides and clostridium) were also isolated in few cases. Edema at site of bite (hematotoxic) and ptosis(neurotoxic) were most common initial presentation. 36.17% of patients received ASV (Anti- Snake Venom) and first aid within 6 hours of snake bite. The morbidity and mortality were significantly less (p&lt;0.05) as compared to those who didn't receive ASV. 12.76% of cases with normal CRT (Clot Retraction Time) presented with features of coagulopathy. DIC (58.33% of hematotoxic bites) and respiratory paralysis 68 (75% of neurotoxic bites) were the commonest complications. Renal replacement therapy was required in 6.38%, transfusion in 10.63% cases and case-fatality-rate was 12.7%. There were a few atypical presentations of snake bite mimicking Gullain-Barre syndrome, acute onset encephalitis with absent brainstem and pupillary reflexes, intracerebral hemorrhage and cortical blindness.Conclusions: Most snake bites are non-poisonous. Early first aid and ASV administration has better outcome. Fibrinogen levels are more reliable than CRT to diagnose coagulopathy. Acute presentations i.e, altered sensorium, paralysis, blindness and stroke like features should always be evaluated for snake envenomation in suspected cases to prevent morbidity and mortality.

A prospective study on clinico-epidemiological profile and outcome in management of poisonous snake bite

Background: Snake bite is a major health problem in Nepal. According to WHO, annual morbidity due to snake bite is 162 out of 100,000 people in Nepal. Aim of the study is to observe epidemiology, clinical features, and analysis of possible relationship between time delay in administration of anti-snake venom (ASV) and mortality. Methods: This prospective observational study analyses the data of 81 patients admitted to the Lumbini zonal hospital, Butwal, Rupandehi, Nepal with history of snake bite between April to September, 2017.Results: In this study 56% patients were female. Patients of age group (15-30) years were maximum (38.27%). The study showed that 50.61% of snake bites were occurred outside home. Most of patients (84%) were from the Terai region. Average no. of vials used per case was (28±10) vials. Most of victims of snake bite were from rural areas. In most of cases we found that prothrombin time was prolonged. It was found that most of patients 57% reach hospital before 4 hours of snake bite. The mean days of hospital stay was 6±2.86. Most of case of snake bite was unknown (62%). The mortality rate in this study was 6.17%.Conclusions: There is a great need to improve in existing health care conditions for effective management of snake bite; it requires training of the personnel engaged in the emergency health care management, development of national guidelines based on the clinical trials, improving the distribution and easy availability of antivenom.

A retrospective analysis of snake envenomation in the intensive care unit of a tertiary care hospital in Delhi

Objective: To evaluate the epidemiology, clinical profile and treatment for patients with snake bite in the intensive care unit of our hospital. Methods: A retrospective analysis of patients with snake bite admitted to the intensive care unit of a tertiary care hospital, North Delhi, was conducted between January 2013 and October 2018. Their demographic profile, time and site of bite, clinical manifestations and time interval between the bite and anti-snake venom administration were recorded. Results: A total number of 102 patients with snake bite were studied, of which 54.9% were males and 45.1% were females. Most patients were presented in the monsoon season and snake bites occurred mainly in the night and early morning. A total of 56.3% of the patients with clinical manifestations received anti-snake venom within 3 h after the snake bite. Most patients presented with painless bites and neuroparalytic features with ptosis that was the most common clinical manifestation (50.9%). Anti-snake venom was administered to 55 patients (53.9%) with an average dose of 42 vials per patient and the mortality was 11.7%. Conclusions: Neuroparalytic krait envenomation accounted for the highest incidence of venomous bites in our study. Early medical treatment with judicious anti snake venom administration and related education is crucial.

Incidence & management practices of snakebite: A retrospective study at Sub-District Hospital, Dahanu, Maharashtra, India.

This study was undertaken to know the incidence and management practices of snakebite envenomation at the First Referral Unit - Sub-District Hospital, Dahanu, Maharashtra, India. Retrospective analysis of snakebite case records (n=145) was carried out for one-year period (January to December 2014). The annual incidence of snakebite was 36 per 100,000 population with case fatality rate of 4.5 per cent. Venomous snakebites were 76 per cent and non-venomous snakebites were 24 per cent. Overall, snakebites were more common in males (52.4%) than females (47.6%). Majority of the snakebites (66%) were in the age group of 18-45 yr. Seasonal variation was observed with highest snakebites in monsoon (58%). Lower extremities were the most common site of bites (63%). Neurotoxic and vasculotoxic envenomation were reported in 19 and 27 per cent snakebite cases, respectively. Anti-snake venom (ASV) was administered at an average dose of 7.5±0.63 vials (range 2-40, median 6). There was no uniform protocol followed for ASV administration as per the National Snakebite Management Protocol of Government of India (2009).

A 6 months retrospective observational study to assess the rationality and effectiveness of snake bite management in a tertiary care teaching hospital of rural Bengal, India

Background: Snake envenomation is a common life-threatening problem encountered all-over West Bengal particularly in the rural areas. There are a large number of patients attending the Emergency unit and being admitted to the Medicine ward, some in the intensive care unit (ICU) and intensive therapy unit (ITU) of the tertiary health care facilities. The objective of this study was to assess rationality and effectiveness of management of venomous snake bite following standard protocol – Standard treatment guidelines of Government of West Bengal and National snakebite management protocol of Government of India.Methods: This was a retrospective observational study of six months (May - October 2017) duration. Data were collected from the treatment records of patients admitted with history of snake bite in the Medicine ward, ICU and ITU of tertiary care teaching hospital of rural Bengal.Results: Of the 63 venomous bite patients, most (82.5 %) were diagnosed to have features of neurotoxic envenomation. All of them (100%) received anti-snake venom (ASV). There was no incidence of anaphylactic reaction as well as any serious adverse drug reaction following ASV administration. Two patients developed acute renal failure, needed haemodialysis. Overall percentage of mortality was 3.2%.Conclusions: The survival rate in venomous snake bite is found to be high in this institution. The practice of snake bite management is found to be adherent with standard protocol. A multicentric study of longer duration is suggested to draw a firm conclusion.