Table of Content - Volume 10 Issue 1 - April 2018

A study 50 cases of clinical outcome and analysis of cases of snake bite admitted at P.D.U. hospital

Vaishali N Vegada¹, Hiren N Makwana^2*

¹Assistant Professor, Department of Medicine, Pramukhswami Medical College, Karamsad, Anand, Gujarat, INDIA.

²Assistant Professor, Department of Medicine, Shri M.P. Shah Medical College, Jamnagar, Gujarat, INDIA.

Email: dr.hiren1910@gmail.com

Abstract Background: Snake bite has become a very important preventable public health hazard. Snake bite usually take place in villages and forests. About 2 million people are bitten by snake and about 35000-50000 cases prove fatal showed the mortality of about 1.75% to 2.5% due to snake bite. Objective of study: 1. To study the various complications of snake bite 2. To study the overall outcome of snake bite. 3. To study the cause of death in snake bite patients. Methodology: 50 cases of snake bite admitted at P.D.U hospital, Rajkot were studied, from December 2015 to July 2017 during the season of monsoon and post monsoon starting from June 2016. The clinical history and examinations were carried out in detail, all necessary investigations done, their clinical course and development of complications were studied, then outcome and analysis of cause of death were recorded. Observations: Most of cases of snake bite occurred in rural areas with 70 % of cases whereas only 30 % cases in urban areas. The highest incidence of snake bite is between May to August 37(72%) and the incidence in post monsoon is 26%. In clinical evaluation 44(88%) had symptoms of toxic snake bite within 3 hours and 6(12%cases) took >3 hours to develop symptoms. On examination local pain was reported in almost all cases 42(84%) out of 50 cases and local swelling was reported in 34(68%) cases. Local bleeding occurred in 24 (48%) cases which is the commonest manifestation, whereas other haematological manifestations like Heamaturia, Heamoptysis, Hemetemesis and Epistaxis occurred in 1 (2%) cases. Neurological manifestation like blurring of vision 23 (46%) cases, difficulty in breathing 20 (40%) cases and ptosis 20 (40%) cases. Local complications like cellulitis occurred in 29(58%) cases and systemic complications like bulbar palsy in 20(40%) cases, respiratory paralysis in 20(40%) cases, DIC occurred in 3(6%) cases. In outcome highest mortality noted in 2 cases out of 9 cases (22%) of cobra bite whereas 1 case died out of 9 cases of krait bite. in analysis of cause of death 2 cases were died due to respiratory paralysis and 1 case due to haematological toxicity. Conclusion: Most common presentation was cellulitis and bulbar and respiratory paralysis. Majority of the patients complicated and died due to respiratory failure.

Key Word: Snake bite.

INTRODUCTION

India has always been a land of common and exotic snakes. Snake bite has become a very important preventable public health hazard as a result of urbanization and cutting down of forests. It is believed that in India about 2 millions people are bitten by snake and about 35000-50000 cases prove fatal. This amply reflects the magnitude of the problem. Snakes are ubiquitous species of reptiles, around 216 varieties are found in India, of which about 52 are venomous. Only four varieties of snakes are commonly encountered as a cause of snake bite poisoning⁶.

Russell’s viper
Saw scaled viper
Krait
Cobra

MATERIALS AND METHOD

50 cases of snake bite admitted at P.D.U hospital, Rajkot were studied, from December 2015 to July 2017 during the season of monsoon and post monsoon starting from June 2016. The clinical history and examinations were carried out in detail, all necessary investigations done, their clinical course and development of complications were studied, then outcome and analysis of cause of death were recorded.

OBSERVATIONS

Most of cases of snake bite occurred in rural areas with 70 % of cases whereas only 30 % cases in urban areas. The highest incidence of snake bite is between May to August 37(72%) and the incidence in post monsoon is 26%. In clinical evaluation 44(88%) had symptoms of toxic snake bite within 3 hours and 6 (12%) cases took >3 hours to develop symptoms. On examination local pain was reported in 42(84%) out of 50 cases and local swelling was reported in 34(68%) cases. Local bleeding occurred in 24(48%) cases which is the commonest manifestation, whereas other haematological manifestations like Heamaturia, Heamoptysis, Hemetemesis and Epistaxis occurred in 1(2%) cases. Neurological manifestation like blurring of vision 23 (46%) cases, difficulty in breathing 20 (40%) cases and ptosis 20(40%) cases. Local complications like cellulitis occurred in 29(58%) cases and systemic complications like bulbar palsy in 20(40%) cases, respiratory paralysis in 20(40%) cases, DIC occurred in 3(6%) cases. In outcome highest mortality noted in 2 cases out of 9 cases (22%) of cobra bite whereas 1 case died out of 9 cases of krait bite.in analysis of cause of death 2 cases were died due to respiratory paralysis and 1 case due to haematological toxicity.

Figure 1: Complications Of Snake Bite

Table 1: Outcome And Type Specific Mortality

Type of snake	No. Of cases	Expired	% of type specific snake mortality
Saw Scalded Viper (Paidka)	24	0	0
Russell’s Viper	2	0	0
Cobra	9	2	22 %
Krait	9	1	11 %
Unidentified	6	0	0

Table 1 shows the outcome and type specific mortality, the highest mortality noted in 2 cases out of 9 cases of cobra bite which is 22% whereas 1case died out of 9 cases of krait bite.

Table 2: Cause Of Death

Cause of death	No. Of cases
Respiratory paralysis	2
Periphery circulatory failure shock	1
Cardio toxicity	O

Table 2 shows the cause of death. 2 cases are of respiratory paralysis due to cobra bite and died in spite of ventilatory support. 1 case died due to haematological toxicity. Cardio toxicity is not reported because of snake bite

DISCUSSION

In present study 50 cases of toxic snake bite were studied, who were admitted at P.D.U hospital Rajkot. The data collected in in present study were compared with other studies and details are as follow:

Table 3: Local Manifestations Of Snake Bite

Local manifestation	Bhimani’s study	N. Dhal study	Gohel’s study	Present study
Local pain	44%	100%	65%	84%
Local swelling	33%	100%	63%	68%

The incidence of local pain and swelling ranges from 70-80%. This is local effect of venom.

Table 4: clinical presentation

Symptoms and signs	R. K khatri study	Bhimani’s study	N. Dhal’s study	Gohel’s study	Present study
Local bleeding		71.42%	35%	27%	48%
Other bleeding tendency		39%			2%
Blurring of vision	40%			96.4%	46%
Difficulty in breathing				32%	40%
Ptosis	60%	92.85%		96.5%	40%

The most common clinical manifestation of snake bite is local bleeding. In present study it is comparable with other existing studies. However other bleeding manifestation of toxic snake bite is approx. 2% The next common clinical manifestation of toxic snake bite is blurring of vision occurred 46% in present study. Ptois and difficulty in breathing occurs in 40% of patient.

Table 5: mortality

	R.K khatri study	Bhimani study	Nims study	Gohel’s study	Tarun Gera study	Present study
Mortality	0%	12%	4%	7%	10%	6%

The minimum mortality ranges in between 4-10% in various studies. Which can be still minimized by increase awareness of public early hospital admission, after the bite early envenomation a good ICU with available artificial respiratory devices, under expert supervision and a good blood bank which may supply either whole blood or blood products round the clock as and when required. The mortality in present study was 6%. Respiratory paralysis was the most common cause of death.

CONCLUSION

Cellulitis was most common complication (58% cases) followed by respiratory failure and bulbar palsy (40% cases). There were about 3 (6% cases) of mortality out of which 2 had a cobra and 1 had a viper bite. Respiratory paralysis was the most common cause of death.

REFERENCES

N. Mohapatre: Neurotoxic snake bite and factors affecting mortality SGB Medical college, Cuttack Orissa.
Bawaskar H.S : profile of snake bite envenomation in western maharasthra, India Trans R sco Trop Med Hug 2002 Jan- Feb 96(1):79-84
Bawaskar H.S Envenomation by the common krait and Asian Cobra: Clinical Management and their manifestation in rural settings. Wilderness environ Med- 2004 winter 15(4)257-66
Benvenuti LA, Pulmonory Hemorrhage causing death after Bothrops Snake Bite Toxicon 42(3) 331-4; sept 2003.
Blaylok R S: Femoral vessels entraptment and compartment syndromes following snake bite south African journal of surgery 41(3) 72-3 Aug 2003.
Daniel J C: The book of Indian Reptiles 1993
Erceg M: Supparative Coxitis of the A viper bite SO ACta Medica Croatica 57(4):309-13, 2003.
Gohel and Patel L: Dissertation submitted to Saurasthra University.
H S Bawaskar Snake venom and Anti Snake venom critical supply issue JAPI 2004, 52, 15-13.

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