Title: To Study S.CRP & S.LDH Levels in Snake Bite Patients as a Markers of Hemotoxicity
Authors: Dr Metta Ranjini, Dr Padam Vijay Kumar, Dr Toleti Sai Phanindra, Dr M. Madhusudhana Babu, Dr Kanugula Sudheer, Dr B.Ashok Babu, Dr M.Yugandhar
DOI: https://dx.doi.org/10.18535/jmscr/v9i1.16
Abstract
Snake bite is considered as one of the medical emergency, either hemotoxic, neurotoxic, cytotoxic or a combination of these. The consequence of envenomation can range from minimal local tissue injury to multi-organ dysfunction. It is suspected that snake venom functions as an acute-phase reactant and interacts with target cells such as macrophages that release inflammatory mediators such as IL(Interleukin)-6 and 8. IL6 is believed to act on the liver, increasing acute phase reactants' production like c-reactive protein, ESR, serum amyloid, haptoglobin, etc1. Hemolysis, a typical manifestation of snake bite is thought to generate phospholipase, an essential component of snake venom. Serum lactate dehydrogenase (LDH) levels found to be associate well with snake venom hemotoxicity and snake bite envenomation severity2. The ability to detect grade of envenomation at presentation is that of challenge and novel markers for the same would be a good guide for treatment as well at prognosis. Snakes are categorized into four families; these are Elapidae, Hydrophidae, Atractaspididae and Viperidae. In Indian subcontinent major families found to be Elapidae, which includes Common cobra, king cobra and krait, Viperidae that includes Russells viper, Pit viper and Saw-scaled viper and Hydrophidae.3
Of the 70 poisonous species in India majority of bites and consequent mortality is attributable to 5 species which are King Cobra (Ophiophagus Hannah), Common Cobra (NajaNaja), Russells viper (Daberia Ruselli), Saw-Scaled viper (Echis Carinatae) and Krait (Bungarus Caeruleus).3
References
- Kasturiratne A, Wickremasinghe AR, De Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The Global Burden of Snakebite:A Literature Analysis and Modelling Based on Regional Estimates of Envenoming and Deaths. PLoS.Med. 2008;5(11):e218.
- Xie Y, Fu Q. The Relation of C-Reactive Protein of Sera With State of Toxicosis in Patients Bitten by AgkistrodonHalys. J of NanhuaUniv 2008;3:346-9.
- Daniel JC. The book of Indian reptiles and amphibians. Mumbai oxford university press 2002; 1:74-5.
- Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Engl J Med. 2002; 347:347–56.
- Bhagwat K, Amar L.Blood hemoglobin, lactate dehydrogenase and total creatine kinase combinely as markers of hemolysis and rhabdomyolysis associated with snake bite. Int.J.Toxicol. Pharmacol.Res. 2013; 5:5-8.
- Kandasamy S, Gopalakrishnan S, Venkatesan M, Ramakrishnan M. The clinical and biochemical profile of snakebite patients-A hospital based comparative study of envenomed and nonenvenomed victims. Int. J. Biochem. Biotechnol. 2014; 3(2):511-15.
- Harshavardhana HS, Pasha I, Prabhu NCS, Amira, Ravi P. Snake Bite Induced Coagulopathy: A Study of Clinical Profile and Predictors of Poor Outcome. Int J Sci Stud. 2014; 2:2-5.