Study of snake bite cases at Liaquat University Hospital Hyderabad/Jamshoro

Abstract

Background: Envenoming resulting from snakebites is an important public health hazard in many regions. It is common in rural areas not to delay access to life saving anti-venom. The objectives of this study were to know about common types of snakes in local areas, clinical features in snakebite victims, complications in snakebite case, and mortality rate in snakebite victims in rural Sindh.

Methods: This descriptive study was conducted at 4 medical wards of Liaquat University Hospital Hyderabad/Jamshoro, Sindh from 1st January 2006 to December 2006. One hundred cases with history of snakebite were analysed. Both genders were included in study. Patients with history of trauma, insect bite or thorn prick were excluded from the study. Clotting time (CT) was the main bedside procedure, to assess the degree of envenomation.

Results: One hundred (100) cases from both genders, from 8 to 55 years age were reviewed. There were 57 (95%) viper bites (haemotoxic) having haemostatic abnormalities and 3 (5%) elapid (neurotoxic) bites presented with neuroparalytic symptoms. Most cases were from Tando Mohammad Khan and Hyderabad (rural) districts of Sindh. All viotims had localized oedema at the site of bite. Fang/teeth marks were noted in (90%) cases. Majority (80%) were bitten on the legs below knee. Some 40% of the cases of snakebite occurred when the patient was asleep. Urban to rural ratio was 1:4.5 and male to female ratio was 4:1. Mean time to arrival at our hospital after the bite was 3 hours and mean duration of hospital stay was 4 days. One patient had acute renal failure (ARF) and disseminated intravascular coagulation (DIC), 3% cases of elapid bites were shifted to ICU for assisted ventilation, 4 patients (5.5%) had adverse effects after anti-venom administration and needed intravenous hydrocortisone, promethazine and subcutaneous adrenaline. The average dose of anti-venom was 60 vials for viper bites and 10 vials for elapid bites. Overall mortality rate was 4%.

Conclusions: Snakebites are common in the rural population of developing countries. There is need to educate the public about the hazards of snake bite, early hospital referral and treatment.