A retrospective study of use of polyvalent anti-snake venom and risk factors for mortality from snake bite in a tertiary care setting

Abstract

Aims:Envenomation with poisonous snakes is associated with considerable morbidity and mortality. The present study was undertaken with the objectives of assessing anti-snake venom (ASV) use, early adverse reactions to ASV, premedication and clinical outcomes in snake bite patients. Association of various risk factors (age, gender, dose of ASV, time gap between snake bite and ASV administration, use of mechanical ventilation and type of snake bite) with mortality was also assessed.Settings and Design:This retrospective study was conducted at two Tertiary Care Teaching Hospitals.Subjects and Methods:The medical records of 176 patients of snake bite with documented use of ASV were retrospectively analyzed to retrieve relevant data.Statistical Analysis:Descriptive statistics was used to express results about ASV use, early adverse reactions to ASV, premedication and clinical outcomes. Univariate and multivariate analysis was performed to find out significant risk factors associated with mortality.Results:The main indication for ASV was vasculotoxic snake bite (75%) followed by neurotoxic snake bite (16%). Mean dose of ASV was 18.63 ± 14.52 vials. Prophylactic premedication with corticosteroids alone or in combination with antihistaminic was used in more than 70% patients. Early adverse reactions to ASV were seen in 4% patients. Neurotoxic snake bite was a significant risk factor associated with mortality in multivariate analysis.Conclusions:Neurotoxic snake bite is an independent predictor of mortality in snake bite patients. Currently used polyvalent ASV may be less effective in treating neurotoxic snake bite.

Trends in snakebite deaths in India from 2000 to 2019 in a nationally representative mortality study

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The Urgent Need to Develop Novel Strategies for the Diagnosis and Treatment of Snakebites

“…However, choosing the correct antivenom is frequently not an option, as there is often only one choice. In many of the problem areas the antivenom used is polyvalent; in India an antivenom raised against the ‘Big Four’—Indian Cobra ( Naja naja ), Russell’s Viper ( Daboia russelii ), Indian krait ( Bungarus caeruleus ) and Saw-scaled viper ( Echis carinatus )—is used [185]. Similarly, the most widely used antivenom in Africa is polyvalent (SAVP) and is raised against 11 species: Black mamba ( Dendroaspis polylepis ), Green mamba ( Dendroaspis angusticeps ), Jameson's mamba ( Dendroaspis jamesoni) , Cape cobra ( Naja nivea ), Snouted cobra ( Aspidelaps lubricus ), Egyptian cobra ( Naja haje ), Forest cobra ( Naja melanoleuca ), Gaboon viper ( Bitis gabonica ), Mozambique spitting cobra ( Naja mossambica ), Puff adder ( Bitis aerietans ) and Rinkhals ( Haemachatus hemachatus ) [186], meaning a small fraction of the antibodies is specific for each snake bite.…”

The North-South divide in snake bite envenomation in India

“…[345678] South Indian snakes predominantly cause hemotoxicity or nephrotoxicity in 83.59% of cases (1965 envenomations) [Table 1]. [910111213141516] This trend becomes apparent as we move Southward from Delhi early as Maharashtra, which has thus been included by us in South India. North Indian snakes predominantly cause neurotoxicity in 70.95% of cases (877 envenomations) [Table 2].…”

“…[345678] P < 0.05 Our research shows that the Russell's viper is virtually nonexistent in North, and there is enough published evidence to prove this fact. [345678910111213141516] Neurotoxic snake Krait is responsible for high mortality throughout North India. [345678] Hence, the North Indian profile is neurotoxicity predominant (Krait), and South Indian profile is hemonephrotoxicity predominant (Russell's and saw-scaled vipers).…”