Management and Outcome Study of Snake Bite Cases in Central India

Snake-bite is a life-threatening medical emergency & major public health problem throughout the World, especially in tropical countries like India. The annual death rate due to snake bite in India is estimated to be 4.1 per 1,00,000 population while in Maharashtra, it is 3.0 per 1,00,000 population. The objective of this study is to observe the management of snake bite and their outcome in central India. It was a prospective observational study of 203 patient of snake bite from June 2011 to September 2013. Inclusion criteria: all the adult patients of poisonous snake bite admitted in medical wards and intensive care unit. Exclusion criteria: patient of non-poisonous snake bite & scorpion bite. Most important investigation to be performed in vasculotoxic snake bite was 20 minute whole blood clotting time which helped in early detection of coagulopathy and subsequent acute renal failure. Complete blood count, liver function test, renal function tests, urine examination to rule out haematuria, coagulation profile (PT and INR) were also done. Primary outcome was defined in the form of survival or non-survival. Prognostic factors were compared in survived and non survived groups. Variable clinical presentations were noted starting from cellulitis (90.6%) followed by nausea and vomiting (70.4%), ptosis (19.2%), colour changes in form of bluish discoloration of bite site (12.8%), respiratory failure and haematuria (7.4%) to Hypotension (6.9%). Out of 203 cases studied 30, patients were died during the study period and overall mortality was 14.8%. Mortality in patients who received ASV more than 300 ml was higher than those who received anti-snake venom (ASV) less than 300 ml (p value < 0.001). To conclude, it was found that in order to reduce the mortality by snake bite, it is important for the patient to reach to the hospital as early as possible so as to get appropriate and adequate treatment with anti-snake venom to prevent the development or progression of complications with proper intervention. Those patient who developed dreadful complications like renal failure requiring dialysis may not be benefited only by giving more amount of ASV (ASV>315 ml) and same is true with coagulopathy.