A study of outcome of neuroparalytic snake bite patients treated with fixed dose of antisnake venom

Authors

  • Ashish S. Kakaria Assistant Professor, Department of Internal Medicine, SBHGMC, Dhule, Maharashtra
  • Meenakshi Narkhede Professor, Department of Internal Medicine, SBHGMC, Dhule, Maharashtra
  • Sanjay Agrawal Associate Professor, Department of Internal Medicine, SBHGMC, Dhule, Maharashtra
  • Abhijit Bhavsar Assistant Professor, Department of Internal Medicine, SBHGMC, Dhule, Maharashtra
  • Vivek Nukte Assistant Professor, Department of Internal Medicine, SBHGMC, Dhule, Maharashtra

Keywords:

Snake bite envenomation, ASV, Respiratory failure, Neuroparalysis

Abstract

Background: Dhule district in Maharashtra (India) has snake bite as a common medical emergency. There are 168 villages in Dhule district and its majority of the population is engaged in farming and snakebite is a major occupational hazard particularly during the harvesting season. The available data on the epidemiology of snake bite from the here is sparse. Poisonous and nonpoisonous snake bites accounts approximately 30 admissions per month which increase to 35-40 admissions in rainy season in Civil Hospital.

Methods: Fifty patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to medical ICU for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of antisnake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated.

Results: 60% of patients affected were in the age group of 21-40 years. Maximum numbers of bites were during April to September (84%). All patients had severe manifestations such as ptosis, ophthalmoplegia, neck muscle weakness, limb and respiratory muscle weakness. 200 ml ASV was administered to all, along with atropine and neostigmine. Mechanical ventilation was required for a median duration of 26.60 hours. All victims in the study group survived with complete neurological recovery except one mortality for a patient who had suffered irreversible hypoxic cerebral injury prior to arrival in hospital and needed ventilatory support for 9.58 days.

Conclusions: Timely institution of ventilatory support and fixed dose of 200 ml of ASV along with anticholinesterase treatment was sufficient to reverse neuroparalysis in severe elapid bites.

 

References

Kasturiratne A, Wickramsinghe AR, DeSilva N, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLOS Med. 2008; 5:e218.

Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, et al. Snakebite mortality in India: A Nationally Representative Mortality Survey. PLoS Negl Trop Dis 5(4): e1018.

Simpson ID, Norris RL. Snakes of medical importance: Is the concept of big four still relevant and useful? Wilderness Environ Med. 2007; 18:2-9.

Warrell David A. Guidelines for the clinical management of snakebites Geneva, World Health Organization, 2010: http://www.searo.who.

Paul V, Pratibha S, Prahlad KA, Earali J, Francis S, Lewis F. High-dose anti-snake venom versus low-dose anti-snake venom in the treatment of poisonous snake bites- a critical study. J Assoc Physicians India. 2004; 52:14-7.

Tariang DD, Philip PJ, Alexander G, Macaden S, Jeyaseelan L, Peter JV, Cherian AM Randomized controlled trial on the effective dose of anti-snake venom in cases of snake bite with systemic envenomation. J Assoc Physicians India. 1999; 47(4): 369-71.

Avinash Agrawal, Alok Gupta, Arjun Khanna. What dose of anti-snake venom should be given in severe neuroparalytic snake bite? Ann Thorac Med. 2011; 6(1): 47–48.

Indian National Snakebite Protocols 2007. Indian National Snakebite Protocol Consultation Meeting, Delhi. Neurotoxic envenomation. August 2007, pg. 21.

Seneviratne U, Dissanayake S. Neurological manifestations of snakebite in Sri Lanka. J Postgrad Med 2002; 48(4):275-78.

N Sharma, S Chauhan, S Faruqi, P Bhat, S Varma. Snake envenomation in a north Indian hospital. Emerg Med J 2005; 22(2): 118-20.

Kulakarni ML, Anees S. Snake venom Poisoning, experience with 633 patients: Indian paediatrics 1994; 31(10): 1239-43.

Harsoor S. S., Dr. Gurudatta C. L., Dr. Balabhaskar, Dr. Kiranchand. Ventilatory management of patients with neuroparalytic envenomation. Indian J. Anaesth. 2006; 50 (6): 452–455.

Fernando P, Dias S. Indian krait bite poisoning. Ceylon Med J 1982; 27(1): 39-41.

Anil A, Singh S, Bhalla A, et al. Role of neostigmine and polyvalent antivenin in Indian common krait (Bungarus caeruleus) bite. J Infection Public Health. 2010; 3:83-7.

Malasit P, Warrell DA et al. Prediction, prevention and mechanism in early complication antivenom reaction in victim of snakebite. Br Med J 1986; 292: 17-20.

Cupo P, Azevedo-Marques MM, de Menezes JB, Hering SE. Immediate hypersensitivity reactions after intravenous use of antivenin sera: prognostic value of intradermal sensitivity tests. Revista do Instituto de Medicina Tropical de Sao Paulo 1991; 33: 115–22.

Agarwal PN, Agarwal AN, Gupta D, Behera D. Management of Respiratory failure in severe Neuroparalytic Snake Envenomation. Neurology India 2001; 49: 25-31.

Bomb BS, Roy S, Kumawat DC, Bharjatya M. Do we need anti snake venom (ASV) for management of elapid ophitoxaemia. J Association of physicians of India 1996; 44(1): 31-33.

SAM Kularatne. Common krait (Bungarus Caeruleus) bite in Anuradhapura, Sri Lanka - a prospective clinical study.1996-98: Post Grad Med J 2002; 78: 276-80.

Sanmuganathan PS. Myasthenic syndrome of snake envenomation: a clinical and neurophysiological study. Postgrad Med J 1998;74:596-9

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Published

2017-01-26

How to Cite

Kakaria, A. S., Narkhede, M., Agrawal, S., Bhavsar, A., & Nukte, V. (2017). A study of outcome of neuroparalytic snake bite patients treated with fixed dose of antisnake venom. International Journal of Research in Medical Sciences, 2(4), 1676–1682. Retrieved from https://www.msjonline.org/index.php/ijrms/article/view/2484

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Original Research Articles