18100006007 THESIS

TITLE:

“CLINICAL PROFILE, MANAGEMENT AND OUTCOME IN PATIENTS WITH POISONOUS SNAKE ENVENOMATION” 

INTRODUCTION:

Snake bite is a common emergency encountered in the tropical and subtropical

countries which are abound with dense vegetation and vast tracts of agricultural

land. India has always been known as the land of exotic snakes. Of 3000 species of

snakes known to the world, in India, we have around 216 species, out of which 52

are known to be poisonous. In our country, the estimated snake bite deaths are

around 30,000 per year. 1

The highest incidence is in Tamil Nadu, West Bengal,

Maharashtra, U.P and Kerala. 2

Due to the prevailing climatic conditions and due to the fact that a major portion of

the population is rural, with vast agricultural fields, snake bite is a major health

problem. Though the village population is at a greater risk, the urban and suburban

are not always spared. The latter can be attributed to unhygienic city dwelling,

harbouring rodents. In developing countries most of the snake bites occurs to the

agricultural workers during their work in the fields. In developed countries, most

common victims are adolescent and young adults due to their risky behaviour.

The term venomous and poisonous are not the same. “Venomous” indicates

organisms producing toxic material in the specialized gland and injecting through bite

specialized venom apparatus and other means. “Poisonous” refers to detrimental

effects produced by touching or consuming plants/organisms. Poison is found

throughout the organisms but venom is produced in isolated glands. Most of the

world‟s medically significant snakes belong to 4 families – Vipiridae, Elapidaec,

Colubridae and Atractaspidinae.

More than 95% of snake bites occurs over extremities. Snake venoms are complex

mixtures of proteins including enzymes and Low Molecular Weight polypeptides. The

fear of snake bite itself produce symptoms like nausea, vomiting, diarrhoea, cold

clammy skin, syncope regardless of the injection of venom. 3

In general, Viper bites cause deleterious effects on almost any organ system.

Russell‟s viper is implicated in causing Acute kidney injury and neurotoxicity apart

from the usual local signs and coagulation abnormalities. In contrast, Elapidae family

cause more neurotoxic manifestations with little or no envenomation. Exceptions are

African pitting cobras (member of Elapidae family) produce little or no neurotoxicity

but cause severe tissue necrosis and vipers like southern pacific rattlesnake

(Crotalus oreganus helleri), Timber rattlesnake (Crotalus horridus horridus), Western

Diamond Black Rattlesnake (Crotalus atrox), and Mohave rattlesnake (Crotalus

scutulatus) produce significant neurotoxicity. Krait bites are commonly painless and

produce neurotoxicity which won‟t resolve following administration of ASV or

anticholinesterase because of post synaptic blockade. Sea snakes produce

generalized rhabdomyolysis later leads to respiratory failure. 4

Envenomation of various poisonous species present varied clinical pictures for

appropriate scientific management, which is getting hampered by non-scientific

natural treatment resulting in deaths and disabilities. Currently, intense work is being

done on the pharmacological, pathophysiological, toxicological and immunological

aspects of snake venoms to develop an appropriate evidence based treatment to the

snake bite victim. Hence this study was conducted at Department of General

Medicine, Kamineni Institute of Medical Sciences, Narketpally to document and

comprehensively analyse various aspects of snake bite envenomation cases.

AIMS AND OBJECTIVES

AIM:

The aim of the present study is to study the clinical profile, management and

outcomes in patients admitted with poisonous snake envenomation.

OBJECTIVES:

 To study the clinical profile of poisonous snake envenomation cases in KIMS,

Narketpally.

 To categorize type of snake Envenomation from clinical signs and symptoms

and investigations.

 To study the outcome in terms of morbidity and mortality.

MATERIALS AND METHODS:

A single-center prospective study was conducted from October 2018 till the end of

September 2020 in the department of General Medicine, Kamineni Institute of

Medical Sciences, Narketpally, on patients admitted with snake bite envenomation.

Study design – Prospective observational study

Study place – Dept. of General Medicine, Kamineni Institute of Medical Sciences, Narketpally

Study period – 24 months (October 2018 to September 2020)

Sample size – 100 patients

INCLUSION CRITERIA:

All patients with history of snake bite with fang marks and signs of envenomation.

EXCLUSION CRITERIA:

 Patients without signs of envenomation.

 Patients admitted with unknown bite.

 Patients not willing for consent for the study.

LINK TO FINAL THESIS WITH MASTER CHART:

https://drive.google.com/file/d/16qSs2TG5-YxH6oB0t9EpYudZK2FtUIPL/view?usp=drivesdk