International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 203-208
Original article:
Study of clinical profile complications and outcome in patients of snake
bite in pediatric age group
A.M. Lingayat, P.R. Wankhade
Department of Pediatrics, Government Medical College, Aurangabad, Maharashtra, India.
Corresponds to: Dr. A. M. Lingayat, Associate Professor, Department of pediatrics, Government Medical College,
Aurangabad, Maharashtra, India.
Abstract
Introduction: In any language of the world, snake produce’s unimaginable fear and anxiety. Right from the cases where earliest
man lived, snakes would have caused first kind of poisoning.Our aim was to study clinical profile, complications and outcome in
patients of snake bite in pediatric age group.
Design: Present study was conducted in Dept of pediatrics all indoor patients of snake bite. It is a Prospective observational
study in tertiary care centre
Result: Majority had poisonous snake bite (57.81%)of which majority of these bites were vasculotoxic(56.75%) . In outcome,
majority of the patients i.e. (96.88%) survivedand 2 patients died due to respiratory failure .Majority had hospital stay for less
than 3 days(51.56%).
Conclusion: The most common symptom detected was local pain and swelling followed by vomiting,ptosis and altered
sensorium and respiratory difficulty.
Introduction:
Carinatus (Viperidae), Cobras (Elapidae) and pit
In any language of the world, snake produce’s
viper (Crotalidae)
unimaginable fear and anxiety. Right from the cases
100,000 resident Indian rural coastal populations
where earliest man lived, snakes would have caused
definitely speak the magnitude of the problem.
first kind of poisoning. The death caused then, might
Material and methods:
have been first alarm of sensing death at vision of a
The study was conducted during January 2013-
13.
14
. Death figures up to 5.4 per
snake Annual mortality from snakebites continues
November 2014 in dept of pediatrics, tertiary care
to be as high as 30 to 40 thousand in the world. Snake
centre. 64patients of both sexes aged 0-12 years
bite, is almost always an accident. Snakes are legless
having snake bite were included in the study. Patients
cold blooded reptiles. Of the 2500 – 3000 species,
with doubtful history of snake bite but with definite
about 500 belong to the four families of venomous
acute onset of signs and symptoms of local or
snakes and only about 200 species are poisonous.
systemic envenomation were also included in study.
Nearly 3500 species of snakes exist in the world.
Exclusion criteria include bites due to other
India has about 216 varieties of snakes of which
poisonous creatures and doubtful cases of snake bite
about 52 are venomous and of these only 4 varieties
where no definite history or acute onset sign and
of snakes are commonly encountered as the cause of
symptoms of envenomation. Complete general and
snakebite poisoning. These are Russell’s viper, Echis
systemic examination was done. The site of the
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ISSN: 2319-7072
International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 203-208
snakebite was examined for any local tissue reaction,
results of study of snake bite in the patients were
such as swelling, erythema, and necrosis. An attempt
shown in Table II. The commonest symptom in these
was made to correlate the pattern of fang marks with
patients was local pain and swelling (90.62%) and
the type of alleged snake.
vomiting (35.94%) followed by ptosis (21.87%).
A detailed examination of central nervous system,
Maximum of patients were admitted within 6hours of
cardiovascular system, and respiratory rate and per
bite
abdomen was carried out in all the cases. Routine and
associated in these patients was cellulitis (32.81%)
specific investigations were done. These include
followed by Neuroparalysis (23.43%) as shown in
hemoglobin
figure.
estimation,
total
leucocyte
count,
(84.37%).The
commonest
complication
differential count, platelet count, PS (Peripheral
Majority had poisonous snake bite (57.81%)of which
smear)- for signs of haemolysis, KFT (serum urea,
majority of these bites were vasculotoxic(56.75%) .
serum creatinin), Urine examination (protein, blood,
In outcome, majority of the patients i.e. (96.88%)
hemoglobin, myoglobin), BT/CT, 20 min whole
survivedand 2 patients died due to respiratory failure
blood
.Majority had hospital stay for less than 3
clotting
time.Specific
Investigation
includesABG/ Serum electrolyte, Prothrombin time
days(51.56%).
(PT), Activated prothrombin time (APTT), ECG.
Discussion
Initial dosage was 5 vials for mild, 10 vials for
The highest incidence at 6-12 yrs could be due to
moderate and 15 vials for severe envenomation was
children involved in labor and farm work.1The higher
administered in intravenous infusion of antisnake
incidence in boys could be due to boys more involved
venom (ASV) after test dose and latter on followed as
in outdoor activities and risky behavior.
16
234
Most
per WHO protocol . Neostigmine along with
cases of snake bite occurringin rainy season & the
atropine was administered to all patients with
incidence varies in India due to different pattern of
neuroparalysis
till
rainfall and agricultural activities.1,
manifestations.
All
complications
during
reversal
of
Neurotoxic
5
Majority of
for
cases were admitted within first 6 hours and this
Blood
helps in assessment of severity of envenomation and
transfusion, ventilator support and dialysis were
administration of antismoke venom. This early
carried
Patients
referral could be due to significant awareness of
received
snake bite and its treatment in rural areas.6
out
developing
as and
severe
patients were
hospital
when
cellulites
studied
study.
indicated.
were
appropriate antibiotics and anti-inflammatory agents
The variation in the snake bike may be due to
and referred to surgeons for necessary treatment.
geographical distribution in various parts of worlds9.
Conditions at the time of discharge were noted. Study
The most common complication was cellulitis
outcome was noted as discharge or death.
followed by neuroparalysis and DIC. Many other
Results:
studies have similar findings.6,10 due to vasculotoxic
The general characteristics feature of these patients of
or neuroparalytic cases.In present study, majority of
snake bite was shown in table 1.Commonest age
cases
group affected was 6-12 years (71.87%) and male
raspiratoryfailure. Many studies observed the same
outnumbers female (Ratio 1.46:1). Maximum patients
findings.11,12
survived
found in month of June to September (87.5%).The
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and
2
patients
died
of
204
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ISSN: 2319-7072
International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 203-208
TABLE .1 SHOWING GENERAL CHARACTERISTICS OF PATIENTS OF SNAKE BITE SSA
CHARACTERISTICS
NO.OF PATIENTS
PERCENTAGE %
AGE DISTRIBUTION
0-1 YR
01
1.56%
1-5 YR
17
26.56%
6-12 YR
46
71.87%
SEX DISTRIBUTION
Male
38
59.37%
Female
26
40.63%
SEASONAL DISTRIBUTIONE
February- May
04
6.25%
June-September
56
87.5%
October-January
04
6.25%
INTERVAL BETWEEN BITE AND HOSPITAL ADMISSION
0-6hours
54
84.37%
6-24 hours
4
6.25%
25 hours and above
6
9.37%
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ISSN: 2319-7072
International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 203-208
TABLE 2 SHOWING OUTPUTS OF PATIENTS OF SNAKE BITE
FINDINGS
NO.OF PATIENTS
PERCENTAGE %
SYMPTOMATALOGY
Local pain and swelling
58
90.62%
Ptosis
16
21.87%
Vomiting
23
35.94%
Respiratory Difficulty
09
14.06%
Altered sensorium
11
17.18%
TYPE OF BITE
Non-poisonous
27
41.19%
Poisonous
37
57.81%
TYPE OF ENVENOMATION
Vasculotoxic
21
56.75%
Neurotoxic
16
43.25%
Cardiotoxic
00
00.00
COMPLICATIONS IN SNAKE BITEN
Cellulitis
21
32.81%
DIC
05
7.8%
Neuroparalysis
15
23.43%
ARF
02
3.12%
Respiratory Failure
05
7.81%
Shock
01
1.56%
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ISSN: 2319-7072
International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 203-208
OUTCOMES IN SNAKE BITE
Survival
62
96.88%
Mortality
02
3.12%
DURATION OF HOSPITAL STAY
1-3days
33
51.56%
4-6days
26
38.71%
More than 6days
05
7.81%
Figure: Showing complications in snake bite.
Complications
No. of Patients
25
20
21
15
15
10
5
5
5
2
1
0
0
0
0
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International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 203-208
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