Clinical Profile and Laboratory Parameters in 1051 Victims of Snakebite from a Single Centre in Kerala, South India.

Introduction: Snakebite is an occupational hazard causing considerable morbidity and mortality worldwide, particularly so in tropical countries like India.
Objective: The aim of this study is to (i) review the demographic, clinical and laboratory findings in patients (1051) admitted with venomous snakebite (ii) to correlate mortality, morbidity and duration of hospital stay with clinical signs, symptoms and laboratory parameters.
Methods: A retrospective study of 1051 patients treated for snakebite over 10 years (2000 - 2009) in Little Flower Hospital, Angamaly, Kerala.
Results: Of the 1051 cases, haemotoxic bites outnumbered 586 (56%) neurotoxic ones 435 (41%). Most victims were males 706 (70%), 792 (75%) of the victims were between 20-60 years of age, lower limb bites predominated, 883 (84%). Among laboratory tests, haemoconcentration (>15 gm/dl), low platelets (<100,000 cmm), proteinuria (3+), raised creatinine (>4 mg/dl) and elevated d-Dimer (>200 µg/ml) were associated with an adverse prognosis. Major complications include death in 38 (3.6%) victims, Acute Respiratory Distress Syndrome 20 (1.9%), Acute Renal Failure 220 (20.9%), needing haemodialysis in 110 (10.4%). Ventilator support was needed in 41 (3.9%) victims and gangrene was seen in 43 (4%). 891 (85%) patients received ASV with adverse reactions in 379 (37%) with 3 having anaphylaxis. The mean dose of antivenom given for neuroparalytic snakebite was 12.26 vials (range 0-32) and 16.79 vials (range 2-52) for hemotoxic bites. 45% of the victims had a hospital stay of <5 days, 40% between 6-14 days and 15% victims of >15 days.
Conclusions: This study highlights that snakebite is an occupational hazard, and the time between bite and treatment determines the prognosis. The low mortality observed in our study is probably due to early admission to hospital, early and adequate ASV administration and better management of complications. The study also indicates that the use of PT and APTT tests along with 20 min WBCT, helped in initiating early treatment. Symptoms of abdominal pain, vomiting, local excruciating pain at the bite site with regional lymphadenopathy even before the prolongation of the clotting time was taken as a sign of systemic envenomation. In the absence of a diagnostic kit, a definite protocol for treatment of snakebite has to be devised.
Abbreviations: Intensive Care Unit (ICU); Polyvalent Anti-snake venom (ASV); whole blood clotting test (WBCT); Acute Respiratory Distress Syndrome (ARDS) ; Acute Kidney Injury(AKI); Disseminated Intravascular Coagulation (DIC); Anterior Wall myocardial infarction (AMI); Cerebro-Vascular Accidents (CVA).