History Of Snake Bite Research Articles

Clinical profile and outcome of snake bite in children admitted in a tertiary care institute in the metropolitan city of Karnataka, India

Background: Snake bite is a major medical and public health problem in tropical agricultural world. A high incidence of snake bite envenomation has been reported from rural India, many times the incidence is underestimated due to lack of epidemiological information. The present study analyses the age, mode of presentation, seasonal variation, clinical profile, management and outcome of patients with snake bite in below 18 years of age group of a metropolitan city, India.Methods: This study is a retrospective single centre study conducted in government referral hospital in Bangalore from January 2016 to January 2020 including 53 patients, who presented with a history of snake bite. Clinical data about age, sex, clinical manifestations, complications, management and outcome were analysed.Results: In our study including of 53 patients, maximum snake bites incidents were noted in age group of 6-10 years (47.16%) of the rural population with male predominance (83.01%). Most of the bites occurred during monsoon season (54.71%) in evening time. Bite marks were observed mainly on lower limbs in 71.69% of patients. Tourniquet was the commonly used first aid care (67.92%). Most of the bites were vasculotoxic in (75.47%) followed by neuroparalytic in 15 patients (9.43%) and maximum cases responded to 20 vials of ante venom. Mortality was nil.Conclusions: Snake bite is a life-threatening emergency. The key in minimizing mortality and severe morbidity is aggressive management of sick patient and timely as well as judicious administration of ante snake venom. There is a requirement to sensitize the general public and healthcare personnel on preventive measures, emergency care and treatment of snake bites. The serious clinical features of snake bite warrant early referral and management in tertiary care centers.

Clinical spectrum and out comes of snake bite patients admitted in a tertiary care hospital , A prospective observational hospital based study

Background: Snakebite is a major public health problem and its prevalence is high in India. Insufficient epidemiological data and global neglect of this condition prompted the World Health organization to recognize it as a ‘‘neglected tropical disease’’
 Objective: To study demographic characteristics of snakebite victims, to see clinical symptoms of bite and outcomes of snakebite.
 Methods: A prospective observational hospital-based study carried out from November 2016 to October 2017, in patients with a history of snakebite.
 Results:Total 300 patients were included in this study,170 (56.67%) were bitten by heamotoxic snakes and 130 (43.33%) were bitten by neurotoxic snakes. Majority of patients were in the age group of 20-39 years ( n=153; 51%). Men outnumbered women( n=190; 63.33%), with male to female ratio of 1.7: 1. Higher incidence of snake bite was found in July – September (n=135;45.00 %) followed by April to June( n=124; 41.33%).Majority of patients were farmers in rural areas ( n=242; 80.80%).Out of 300 patients,80required ICU care.In patients with neuroparalytic snake bites, clinical features were; ptosis (n=126; 96.92%),ophthalmoplegia (n=98; 75.38%),respiratory paralysis (n=60; 46.15%),bulbar weakness ( n=74; 56.92%) andabdomen pain(n=25; 19.23%).Clinical features in patients of haemotoxic snake bites were ; bleeding from bite site(n=110; 65.29%) , cellulitis(n=100; 58.82%), gum bleed(n=53; 31.18%), ecchymosis(n=49; 28.82%),epistaxis(n=27; 15.82%),gastrointestinal bleeding(n=25; 14.71%) andhaemoptysis(n=19; 11.18%). Complications observed were acute kidney injury ( n=62; 20.67%) , respiratory failure ( n=51; 17.00%) , DIC( n=7; 2.33%) and ARDS( n=5; 1.67%) . Out of 170 hemotoxic snake bite patients, 157 (92.35%) patients recovered and 13 (7.65%) patients died and out of 130 neurotoxic snake bites, 124 (95.39%) patients recovered and 6 (4.61%) patients died, overall mortality was 6.3%. In our study, bite to needle time was less than 1 hour in 47 patients (15.66%), less than 6 hrs in 120 patients (40%) and more than 24 hours in 45 (15%).
 Conclusion: Snakebite is common in adult males between 20 to 50 years and the commonest site is the lower limb. The majority of the victims are farmers who work in fields. A maximum number of cases presented within 1-6 hours of bite using a tourniquet on the affected limb as first aid. The complications and mortality of snakebite are high.

A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation

Background: Every year about 50,000, people die of snake bites in India. Anti-snake venom and mechanical ventilation is mainstay of treatment in cases with severe neurotoxic envenomation. ASV is costly and scarce resource. There is lack of universal consensus towards the optimal dose of ASV in management protocol for children with severe neurotoxic snake envenomation. Objective was to compare the difference in outcome between two fixed doses of ASV, 10vials versus 20 vials, in children with severe neurotoxic snake envenomationMethods: This comparative observational study was carried out for a period of 3 years in Department of Pediatrics of SVS Medical College, Mahabubnagar, Telangana, India. Children with history of snake bite and clinical evidence of neuroparalysis were included. In addition to the mechanical ventilation and other supportive measures, every alternate patient was administered with 10vials (low dose) and 20 vials (high dose) of ASV over 1 hour. Outcome was compared between the two groups.Results: Of the 62 patients, 32 were in each group. The median time to extubation was 41 hours and 39.5 hours and mean duration of the hospital stay was 4.6 days and 4.5 days among the low dose and high dose groups, respectively. There were three deaths, one from low dose group and two from high dose group.Conclusions: There was no significant difference in outcome between the 10 vials vs 20 vials of ASV in addition to mechanical ventilation in treatment of children with severe neurotoxic snake envenomation. So, 10 vials of ASV can be utilized to reduce the cost of treatment.

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.

Presentation and complications of snakebite in a tertiary care hospital.

To determine frequency of various modes of presentation, complications and management of snakebite. Descriptive case series. Medical Unit II, Rawalpindi General Hospital, Rawalpindi, Pakistan, from September 2006 to August 2007. All patients over 12 years of age and presenting to emergency department with history of snakebite and features of envenomation were included in the study. All these patients were given Anti-Snake Venom. Symptomatic treatment of complications was done. Semi-structured questionnaire was filled during hospital stay to analyze various characteristics of snakebite and people's attitude towards this problem. A total of 65 patients were enrolled in the study with 40 males (61.5%) and 25 (38.5%) females. Maximum cases 15 (23%) were seen in the month of August. Age group, that was maximally affected, was between 26-30 years (12 cases or 18.5%). Only 2 patients had neurotoxic snakebite, whereas rest of the cases were vasculo toxic in nature. Gum bleeding and cellulitis were the main presenting complaints. Mortality was 4.6% (3 cases). A great majority of patients arrived late in the hospital because of lack of awareness and use of traditional though ineffective measures. Snakebite is a major public health problem. Patients with snakebite can be managed effectively provided timely administration of anti-snake Venom is done.

The role of pyridostigmine in recovery from motor paralysis in a snakebite patient with an allergic reaction to anti-snake venom

A 30-year-old woman presented as an emergency with a history of snakebite 5 h previously with signs of bulbar palsy, ptosis, respiratory distress and weakness of all four limbs. Mechanical ventilation, anti-snake venom (ASV) and supportive management were immediately instituted. With the third dose of ASV, an early anaphylactic reaction ensued. Subsequent management with corticosteroids and antihistamines over the next few days allowed consciousness to return but muscle power did not improve beyond 2/5. A trial of intravenous neostigmine with glycopyrrolate, however, improved motor power in all four limbs to 3/5. Oral pyridostigmine at 60 mg every 8 h allowed subsequent full motor recovery in all four extremities. We suggest consideration of pyridostigmine to promote motor recovery after an allergic reaction to ASV.

A comparative study between retrospective and prospective assessment of rationality and effectiveness of snake bite management in a tertiary care teaching hospital

Background: Snake bite envenomation remains one of the commonest causes of mortality and morbidity in rural West Bengal. Objective of present study was to compare the rationality, effectiveness and adherence to standard treatment guidelines of Government of West Bengal of snake bite management over the high-risk periods of two years.Methods: This was a comparative study of snake bite management between 2016 and 2018 (over April to September) during peak risk season in a tertiary care teaching hospital in rural Bengal. The data was collected retrospectively from the treatment records in 2016 and from patients admitted with history of snake bite in the Medicine ward, ICU and ITU in 2018.Results: Records from 2016 yielded 177 snake bite patients (144 venomous and 82.5% neurotoxic envenomation) and in 2018, 190 cases (114 venomous and 71.1% neurotoxic). There was delay in presentation (>2 hours) in almost 80% cases in both years and 2.56% had anaphylactic reaction following ASV administration in 2018 against 3.15% in 2016. Ventilator support was necessary for 12% patients in 2018. Overall percentage of mortality reduced from 6.70% to 3.2% in 2018. Adherence to snake bite management STG was seen in 81.8% of the retrospective records vis a vis 80% cases in prospective analysis (p = 0.21).Conclusions: The survival rate in venomous snake bite is found to be high in this institution over last two seasons of snake bite. The practice of snake bite management is found to be adherent with standard protocol in most cases.

Snake envenomation: is the 20 min whole blood clotting test (WBCT20) the optimum test for management?

The 20 min whole blood clotting test (WBCT20) is a simple bedside test recommended by World Health Organization (WHO) to assess hemotoxic envenomation and guide administration of polyvalent anti-snake venom (ASV). However, reliability and validity of this test has not been well documented in literature. Sixty consecutive patients with history of snake bite were prospectively evaluated at a teaching hospital in India over 2 years. Envenomation was established by clinical and laboratory criteria. WBCT20 was done at 0, 4 and 12 h using standardized protocol. Prothrombin time (PT) with international normalized ratio (INR) was estimated at similar intervals to detect venom-induced consumption coagulopathy. Sensitivity, specificity and likelihood ratios (LR) were determined for WBCT20 using envenomation criteria as gold standard. WBCT20 was compared with PT/INR at cutoff values of ≥1.4 and ≥1.2. Two observers performed test-retest correlation to determine inter-observer variability of WBCT20. . WBCT20 is a highly sensitive test with excellent reliability for detecting envenomation. However, the false positive rate in this study was 24%. Asymptomatic snake bite patients with a positive WBCT20 but no corresponding clinical signs of envenomation should be tested using PT/INR before receiving ASV to prevent unnecessary waste of anti-venom.

A clinico-epidemiological study of snakebite among children in a rural medical college from eastern India

Background: Snakebite is a neglected tropical disease and one of the major causes of mortality in developing countries like India. Methods: A cross-sectional hospital based study was done among paediatric population admitted to the hospital with history of snakebite. Results: Deaths due to snakebite were 2.8% of total death. Most of the cases were during monsoon (55%) and from rural area (93%). Only 13.6% patients came to hospital within 6 hours. Prothrombin time and activated partial thromboplastin time were prolonged in 36.67% and 33.33% cases respectively. The 20-minute Whole Blood Clotting Test (WBCT20) was positive in 47.6% of poisonous snakebites and in 63.6% of vasculotoxic snakebites. 62% cases recovered with 10 vials of ASV, however some needed >20 vials. Conclusion: Epidemiological data are vital for evaluation of exact scenario of snakebite cases. Poor health care seeking behaviour of community increases mortality.

Snakebite and its management in rural West Bengal: The unspoken truth

Background: Snakebite is a common medical emergency in tropical India where agriculture is a major source of earning livelihood. Snakebite has a significant impact on human health and economy. The situation worsens when the majority of snakebite victims adopt harmful practices such as application of tourniquets due to prevalent myths and misconceptions. Objectives: The objective of the study was to study the socio-demographic profile of the study population, to estimate the prevalence of snakebite in the study area, and to assess the knowledge and treatment seeking behavior of the study population regarding snakebite and its management. Materials and Methods: A total of 135 households of Muchisa village of West Bengal were selected by consecutive sampling and one adult member of the household was interviewed with a pre-designed schedule. Results: Majority of the study population were in the age group of 30–60 years (69.5%), females (52.6%), and Hindu (74.8%). Nearly 59.1% (100) of the population were educated up to primary level. Nearly 15.56% of the study population in our study gave a history of snakebite. Nearly 81.1% of study population correctly differentiated between poisonous and nonpoisonous snakebites based on signs and symptoms of the victim. When asked about why snakebite, the villagers said that snakebite when they were touched (57.04%) or hit (33.33%). About 57.78% of the population believed that snakebite can be managed by traditional faith healers (Ojha). The majority preferred tying a tourniquet/similar material above the bite mark. Conclusion: It is essential to communicate about the appropriate management of a snakebite victim to the communities at risk of snakebite.

Assessment of clinical parameters among patients with snake poison induced coagulopathy

Background: Snakes are poikilothermic carnivorous reptiles that have evolved the venomous apparatus for the purpose of procurement of food. Snake bite can result in local and systemic complications. Major systemic complications include acute renal failure, neurologic abnormalities requiring ventilator support and disseminated intravascular coagulation. Disseminated intravascular coagulation can result in serious life-threatening systemic complications like haemorrhage, infarction and even death if the treatment is delayed. The present study was undertaken to study the clinical profile of the snake bite patients who develop coagulopathy and to study the role of coagulation markers to evaluate the morbidity and mortality of snake bite victims.Methods: Hundred patients consecutively admitted with history of snakebite were studied. Patients who have developed local signs of envenomation due to snake bite were included in the study group. The coagulation profile was assessed by doing blood investigations.Results: In this study, patients who developed coagulopathy had prolonged hospital stay and requirement of more blood products transfusion causing increased morbidity. 43 patients (35.8%) had platelets less than 1 lakh and approximately hospitalized for 26 days sand INR was more than 1.5 in 112 patients (93.3%) and hospitalized for 22 days and they received fresh frozen plasma. The survival rate in this study was 86% followed by 13.3% deaths.Conclusions: Use of clinical and laboratory parameter evaluation needed to identify the coagulopathy very early to reduce the hospital stay and mortality.

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.

Management of snakebite victims using low dose antisnake venom in a tertiary hospital in Southern Nigeria: A 5-year Retrospective study

Objective : Antisnake venom (ASV) is a specific antidote for the management of snake bite envenomations. This study profiled the treatment and outcome of adult snake bite victims managed using low dose antisnake venom. Methods: This was a 5-year retrospective study that involved all adult patients who presented in University of Benin Teaching Hospital, Benin City, Nigeria, with a history of snake bite. Information obtained were demographic characteristics, clinical features, and administered treatment per established. All patients with a diagnosis of snake bite envenomation were administered ASV. Results : Sixty patients were seen during the study period, 35(58.3%) males, 25(41.7%) females with a mean age was 34.7±13.3. The mean time from bite to presentation was 14.67±14.05 hours with range of 1- 48 hours. Twenty patients (33.3%) had snake bite envenomations, of these eleven (57.9%) were managed and discharged after administration of 30 to 40 mls of polyvalent ASV. The mean dose of PASV used was 3.9 ± 2.0 vials. The most encountered clinical indication for ASV administration was progressive painful swelling. No death was recorded throughout this period studied. Conclusion : Adoption of the low dose regimen in the management of snake bite envenomations may be as effective as the traditional high dose regimen. Key words: Snake bite, envenomation, polyvalent antisnake venom, Nigeria.

Acute Kidney Injury Secondary To Snake Bite In Patients Presenting To A Tertiary Care Hospital

Objective: To determine the frequency of Acute kidney injury secondary to snake bite in patients presenting to a tertiary care hospital. Subject and Methods: This was a descriptive cross-sectional study conducted at the department of General Medicine, Jinnah postgraduate medical center, Karachi, from 10th June 2015 to 10th Jan 2016. Patients with diagnosis of snake bite were enrolled. Detailed history, physical examination and biochemical measurements were recorded. Patients underwent serum creatinine levels for diagnosis of AKI. Results: One hundred and twelve patients fulfilling the inclusion criteria were included in this study.There were 90 (83.36%) males and 22 (19.64%) females. The mean ± standard deviation age of study population was 28±0.151 years. On analysis of risk factors it was observed that 33 (29.46%) patients were obese. On analysis of outcome variable, it was observed that 33 (29.46%) had AKI. Conclusion: Around 30% of patients who developed AKI were presented with history of snake bite. However, factors such as age, gender, duration and obesity were not related with the AKI.

Maternal and Perinatal Outcome, a Case Report of Disseminated Intravascular Coagulation Following Snakebite after Treatment with Polyvalent Anti-snake Bites

Snakebite is not common during pregnancy, but the obstetric consequences are severe and associated with the severity of envenomation. Early stages of pregnancy and treatment delay are risk factors for the poor prognosis. A 20-year-old pregnant woman in 16 weeks of the first pregnancy referred to Zabol Amir Hospital on August 13, 2015, with the history of snakebite on the right foot. Intravenous fluid, 2 units of packed cells and 4 units of fresh frozen plasma (FFP) were administered, however, the coagulopathy and hematuria remained. Polyvalent anti-snakebite serum was injected. At first, 3 vials (30 mg) were injected and due to lack of improvement, four extra doses (40 mg) of polyvalent anti-snakebite serum were administered; then, at the 5th day she was discharged with a good general condition. The follow up was performed on a regular basis including periodic examination, PT and PTT check. Snakebite during pregnancy can lead to a dangerous condition for the mother and fetus. However, early treatment with polyvalent anti-snake serum and appropriate management improved the outcome of snakebite in pregnancy

Clinico-epidemiological profile of snake bite in children - A descriptive study

Background: Snakebite is one of the important causes of occupational hazard in our country. The state of Bihar has the third largest number of snakebite deaths in India. Objective: Our aim was to study the clinical profile, seasonal pattern, complications and outcome in patients of snake bite in pediatric age group. Materials and Methods: This was a record-based retrospective study conducted at Sri Krishna Medical College, Muzaffarpur. Data were collected for patients admitted between 1 July 2015 and 30 June 2016. Patients were included if they had a history of snakebite or unknown bites. Results: There were 51 males (60%) and 34 females (40%) out of 85 patients studied. Among them, 50 patients had krait bite, 25 patients had Cobra bite, 2 patients had viper bite, and in 8 patients snake was not identified. Majority of the snake bites were in the lower limbs (80.0%). The highest number of cases occurred during June-October month (42%). Mortality in our study was 6%. The most common symptom detected was pain abdomen (80%), ptosis/ophthalmoplegia (82.35%), altered sensorium (29.41%), and respiratory difficulty (35.29%). Conclusions: Common krait (Bungarus caeruleus) accounted for the highest number of venomous bites. Lower limb was the most common bitten site. Victims were from a rural background, and most of them were bitten indoors and during the night time. Identification, timely diagnosis and early administration of anti-snake venom will certainly aid to curb mortality in snake bite.

Clinico-Epidemiological Profile, Health Care Utilization and Practices Regarding Snake Bite at Ilam District of Eastern Nepal

IntroductionSnake bite is neglected problem of the rural agrarian society of the world. Nepal is one of the vulnerable countries of snakebite. The utilization of health care services and practices regarding snake bite is not known.ObjectiveThis objective of the study was to explore clinicoepidemiological profile, health care utilization and practices regarding snake bite at Ilam District of eastern Nepal.MethodologyThis was a cross-sectional study and conducted from th th 25 March to 25 May 2013 using a systematic random sampling of 300 people from communities of Ilam district. The data was collected after receiving informed consent. The collected data was entered into Microsoft excel and analysed by using SPSS.ResultsThe majority (76.7%) of the respondents had seen snakes in their locality. The major snake noticed was mountain pit viper (Ovophis monticola)- Grube (94.8%). Among respondents, 5.3% had a history of snake bite which was predominant among productive age of 15-39 years. The most common bitten part of the body was leg (56.3%). There was no any serious injuries and death. Treatment was done by different modalities such as by using local antidote (31.3%) at the bite site and by soap-clean water (25%). Sixty-nine percent of the snake bite victims utilized modern health care system. Charali snake bite management center, Jhapa was the major treatment center. Seven out of 10 had knowledge of using a tourniquet. After full recovery from a snake bite, 1 out of 5 had avoided milk due to their false belief.ConclusionActive age group was more victimized. The commonest bitten part was a leg. The knowledge of first aid of snake bite was not adequate and many were unaware of post snake bite practices. Reassurance, early first aid and timely transportation to health center save many victims of snake bite.Birat Journal of Health SciencesVol.2/No.1/Issue 2/ Jan - April 2017, page: 179-183

SYMMETRICAL PERIPHERAL GANGRENE POST SNAKE-BITE: AN UNUSUAL PRESENTATION

Snake bite in India is a common yet neglected public health issue, with an estimated death rate of 50,000 per year. Symmetrical peripheral gangrene (SPG) has varied aetiology, but it is an unusual complication after snake bites. SPG is important as it causes significant morbidity and mortality, and early intervention may improve the outcome. Hereby, we report a case of SPG in young female with history of snake bite. The patient developed gangrene of bilateral foot and distal part of legs with necrotising fasciitis of right leg. In the literature, there are only few reported cases of SPG as a complication of snake bite. Keywords: Symmetrical peripheral gangrene (SPG), Snake bite, Necrotising fasciitis

Clinical and Laboratory Parameters Associated with Acute Kidney Injury in Viper Envenomed Cases

Viper species are distributed allover Egypt. Venomous bites by Viperidae snakes are associated with local and systemic manifestations and may be exacerbated by the development of acute kidney injury (AKI). THE AIM of the study was to assess acute renal injury in cases of envenomations by locally prevalent vipers as regards incidence, clinical and laboratory parameters and final outcome. METHODS: The current study was conducted on all patients, of both sex, admitted in Poison Control Center of Ain Shams University hospitals following envenomation by Viperidae snakes during 2014, 2015, and 2016. Diagnosis was based on history of snake bite with suggestive clinical data. Recorded data included patient characteristics (age, gender, delay time), vital data (heart rate, blood pressure), presence of local signs, bleeding manifestations, laboratory parameters (INR, platelet count, hemoglobin level, BUN and serum creatinine), number of antivenom vials used , duration of hospital stay and survival. Cases were sub-grouped to group I with AKI and group II without AKI. RESULTS: A total of 120 cases of venomous bites by Viperidae snakes were recorded during the study period with mortality of 4.2%. Cases were predominantly males with mean age of 35 +/-14.7years. A subset of 5.8% cases developed AKI which statistically was related to older age, longer delay time, increased incidence of bleeding manifestations and tachycardia, higher values of INR, serum creatinine, and blood urea nitrogen, lower platelet count, higher number of used antivenom vials and longer duration of hospital stay. Gender, hypotension, presence of local manifestations and hemoglobin level were insignificant among AKI. Mortality among AKI cases was statistically linked to old age, prolonged delay time, increased incidence of bleeding manifestations, higher INR values, low platelet count and low hemoglobin level and increased number of used antivenom vials and duration of hospital stay. The incidence of tachycardia, hypotension and local manifestations, serum creatinine and blood urea nitrogen levels were not statistically different among non- survivors. CONCLUSION: Acute renal injury may complicate the course of viper envenomations. Venom hemotoxicity is related to morbidity and mortality especially with older age and longer time between bite to antivenom therapy.

Clinical Spectrum and Outcome of Snake Bite Cases in Western Nepal

Background: Prevalence of snake bite is high in Nepal. However, there is no exact figure of mortality and morbidity associated with snake-bite probably due to poor reporting. 
 Objectives: To study demographic characters of snake bite victims, to see clinical symptoms of the bite, outcome of snake bite, use of ASVS and its associated anaphylactic reaction.
 Methods: A retrospective observational hospital based study carried out through July- October 2017 of the patients with the history of snake bite and visited to secondary level hospital (Army Hospital) at Nepalganj.
 Result: Among 169 cases of snake bite between 6 months to 83 years, 49.70% was between 20-54 years. Highest number of cases (n=110) came from local areas of Nepalganj like Manikapur, Alanagar, Fulltegra, Daduwa, Gayatrinagar and Samsherganj. Male victims were 61.53% (n=104) and 38.46% (n=65) were female. Commonest site of bite was in lower limb (n=116), followed by upper limb (n=47), head, neck and trunk. Maximum number of cases came to the center within 90 minutes of bite while only n= 28 came after 180 minutes of bite. Use of tourniquet as first aid was seen in 68% (n=115) and 3 cases came in with incised wound and sucked wound. A total of 97.04% (n=164) were dry bite with 26.62% (n=45) only had suspicion of snake bite (snake not seen due to invisibility or bite other than snake). A majority of cases presented without any other symptoms (with only history of bite), 45.56% had bite marks, 17.16% had pain and swelling at the bite site, 6.7% had bleeding from the site and burning and tingling sensation. A total of 2.95% (n=5) of snake bite cases needed ASVS and one developed ASVS complication.
 Conclusion: Snake bite is more common in adult male between 20-54 years and the commonest site is lower limb. Maximum number of cases presented within in 90 minutes of bite using tourniquet on the affected limb as first aid. Only small percentage of snake bite required anti-snake venom treatment and its complication rate is high.