Clinical Profile and Amount of Antisnake Venom Used in Admitted Cases of Snake Bite Envenomation in Bharatpur Hospital ICU

VP Paudel


Introduction: Snakebite remains a neglected medical problem of the developing world with up to 125,000 deaths each year despite more than century of calls to improve snakebite prevention
and care. It is more prevalent in Terai and Inner Terai regions of Nepal especially during monsoon season. Snakebite can result in life-threatening envenoming and correct identification of the
biting species is crucial for doctors to choose appropriate treatment and anticipate complications. The aim of this study was to address this gap in snakebite patients that presented to Bharatpur hospital and admitted to ICU.

Method: A descriptive cross-sectional study in snakebite patients that were admitted in Bharatpur hospital ICU from February 2016 to February 2017 was taken into consideration. A Standard criterion such as fang mark, ptosis and loss of frowning of forehead was used to identify snake bite patients using relevant history and examination. Amount of antisnake venom used and
length of hospital stay was prioritized.

Result: A total of 54 patients admitted in Bharatpur hospital ICU with snake bite envenomation were studied. Most common snake envenomation was by Krait which accounted for 55.56%
followed by Cobra with 40.74% and Viper with 3.7%. Fang marks were present in 24 cases (44.4%). Amount of anti-snake venom (ASV) used in vials were in between 30-40 vials in 40.74%.
Total number of ASV vials used was 381 while mean number of ASV used was 22 vials. Length of hospital stay was less than 5 days in 68.52%. Among the patients, 27.78% required ventilator
support. Case fatality rate was 9.26% despite ICU treatment.

Conclusion: Majority of snake bite poisoning was by Krait and Cobra, which are neurotoxic and may cause respiratory paralysis requiring ventilatory support and ICU admission. However the study shows that maximum patients required shorter hospital stay and few patients only required ventilator support. Nonetheless, case fatality rate was still higher than expected. Hence this calls for well designed large scale assessment and revised protocols for better management of snake bite envenomation in the days to come.

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