Abstract
Bites due to poisonous snakes especially vipers, are one of the challenging public health problems in India. Envenomation in such cases often leads to massive intravascular hemolysis. Hence this prospective observational study was done to find out the relation between hemolysis and prognosis in patients with viper bites. 107 patients admitted with confirmed or suspected viper bites in a tertiary care centre were included. The sociodemographic details of the patients, time and site of bite, bite to needle time, presence or absence of local reaction, treatment details and relevant laboratory investigation reports were recorded. Lactate dehydrogenase levels, hyperbilirubinemia and reticulocytosis were taken as markers of haemolysis. Duration of hospital stay, recovery or in hospital deaths were noted. Data analysis was done using Microsoft excel 2010. It was found that 61.7 % were males. Bites occurred between 4 pm and 8 pm in 45.8%. Many had local reaction, active bleeding, prolonged clotting time and evidence of haemolysis and were brought to the hospital within 6 hours of bite. 20 vials of anti-snake venom were needed in 41.1% patients. Duration of hospital stay was less than 5 days in 55.1% patients. 92.5% patients recovered and 8 patients died in this study. Statistically significant relation was seen between haemolysis and death in these patients. Thus, it can be concluded that haemolysis occurring in poisonous viper bites can be taken as a prognostic indicator in such patients.
Keywords: Hemolysis, Poisonous snakes, Viper bite, Clotting time, Envenomation.
References
- Narvencar K. Correlation between timing of ASV administration and complications in snake bites. J assoc Physician India 2006;54:717-9.
- David AW. Guidelines for the clinical management of snake bites in the south east region. World Health Organisation, Regional office for south East Asia, New Delhi; 2005:1-67.
- Whittaker R. Common Indian Snakes: A field guide. New Delhi: McMillan India Limited; 2001.
- Hutton RA, Looareesuwan S, Ho M. Arboreal pit vipers (genus Trimesurus) of south East Asia: bites by T. albolabris and T.macrops in Thailand and a review of the literature. Trans R Soc Trop Med Hyg.1990; 84:866-74.
- John P Greer, Maxwell Myer Wintrobe. Hemolytic anemia. Wintrobe’s clinical hematology; Part IV, Section 3; 1028.
- Rodney E Phillips, R. David G Theakston, David A Warrell, Yamuna Galigedara, D.T.D.J Abeysekera, P Dissanayaka, Ronald A Hutton, Dennis J Aloysius; Paralysis,Rhabdomyolysis and hemolysis caused by bites of Russell’s viper ( Vipera russelli pulchella) in srilanka: Failure of Indian(Haffkine) Antivenom QJM: An international Journal of Medicine.1988;68(3-4):691-715
- Ariaratnam CA, Thuraisingam V, Kularatne SA, Sheriff MH, Theakston RD, de silva A, Warrell DA. Frequent and potentially fatal envenoming by hump nosed pit vipers (Hypnale hypnale and H. nepa) in srilanka:lack of effective antivenom. Trans R Soc Trop Med Hyg. 2008 Nov; 102(11):1120-6’
- Kularatne SA. Epidemiology and clinical picture of the Russell’s viper (Daboia russelli) bite in Anuradhapura, SriLanka: a prospective study of 336 patients .South east Asian J Trop Med Public Health.2003 Dec; 34(4):855-62.
- Richard C Dart. Russell’s viper. Medical Toxicology; 1583.
- HS Bawaskar, PH Bawaskar, DP Punde, MK Inamdar, RB Dongare, RR Bhoite: profile of snake bite envenoming in rural Maharashtra.India J Assoc Physicians India 2008.
- Ponlapet Rojnuckarin, Suebsan Mahasa-ndana, Tanin Intragumthornchai, Pranee Sutchaitchan and Daratana wasdikul. Am J Trop Med Hyg1998;58(1):22-25.
- Mohd Haneef. Ophitoxemia-an experience from North Kerala. www.imakmj.com/articles/03
- Al Lawati A, Al Abri SS, Lalloo DG. Epidemiology and outcome of snake bite cases evaluated at a tertiary care Hospital in Oman. Infect Public Health. 2009;2(4):167-70.
- Peterson ME. Snake bite: Pit vipers. Clin Tech Small Anim Pract. 2006 Nov; 21(4):174-82.
- Joseph JK, Simpson ID, Menon NC, Jose MP, Kulkarni KJ, Raghavendra GB, Warrell DA. First authenticated cases of life threatening envenoming by the hump nosed pit viper (Hypnale hypnale) in India. Trans R Soc Trop Med Hyg. 2007 Jan; 101(1):85-90.
- Dong Zong Hung, Ming Ling Wu, Jou Fang Deng and Shoei Yn Lin Shiau; Russell’s viper snake bite in Taiwan; differences from other Asian countries; Toxicon . Sep 2002; 40(9):1291-98.
- Reid HA. Animal poisons. In: manson Bahr PEC, Apted FIC (Eds). Manson’s tropical diseases, 18th London. Balliere-Tindall 1982;544-46.
- O Geetha. Snake envenomation: A hospital based survey from Thiruvananthapuram, Kerala. Journal of the Indian society of Toxicology.2010; 6(2).
Corresponding Author
Dr Aruna R
Additional Professor, Department of Internal Medicine,
Government Medical College, Thiruvananthapuram, Kerala, India
Phone No.: +91 9447753729, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i10.144
