Clinical Profile and Outcome in Patients with Snake Bite in a Tertiary Care Centre in Kerala

Abstract

BACKGROUND The clinical profile and outcome of snake bite varies from place to place and depends on a number of factors including the type of snake bite, place of snake bite, time of bite, season, and duration of presentation after bite. The clinical profile, factors affecting the outcome and the outcome have not been previously well studied. METHODS This is a cross-sectional observational study conducted for a duration of six months from January 2021 to June 2021. Subjects meeting inclusion criteria were enrolled in the study group after obtaining written consent. Patients were evaluated based on the standard pro-forma with detailed history and clinical examination. All relevant investigations to assess systemic envenomation, treatment and outcome were documented in all the patients. RESULTS In the study, 204 (68 %) were male patients and 96 (32 %) were female patients. 108 (36 %) were admitted with venomous snake bite and 192 (64 %) were with non-poisonous snake bite. 52 patients had snake bite on the upper extremities, 234 had snake bite on the lower extremities, 8 patients had snake bite on the trunk whereas 6 patients had bite on other areas of the body. 202 patients had swelling at the bite site, 222 had pain at the site of bite, 86 patients had oozing of blood and 6 patients had vague somatic symptoms. 132 patients had local oedema, 148 had local tenderness, 66 patients had skin necrosis and 16 patients developed blisters at the site of bite. 124 patients had systemic manifestations of which 24 patients had vomiting, 12 patients developed abdominal pain, 10 patients developed anuria/oliguria, 14 patients developed hypotension, 12 patients developed bleeding manifestations, 10 patients developed neurological symptoms and 2 snakebite patients had syncope. Complications and mortality in poisonous snake bite due to renal failure was observed in 38 patients with a mortality of 1 patient, 10 patients developed intravascular haemolysis, 8 patients developed unexplained hypotension, 18 patients developed secondary infection, 4 patients developed intra-cerebral bleeding and 15 patients developed neurotoxity with a mortality of 2 patients. CONCLUSIONS Snake bite is a common problem encountered in tertiary care centres and the most common encountered type of snakebite was haemotoxic bite. Pain at the bite site was the commonest symptom and tenderness at bite site was the commonest sign in patients with snake bite. Mortality in venomous bite was 3.7%. Prolonged bite to needle time, development of renal failure, leukocytosis, neurotoxicity and severe degree of coagulopathy were factors associated with adverse outcome. KEYWORDS Clinical Profile, Outcome, Snake Bite, Tertiary Care Centre