A hospital based study on snake bite poisoning in adults in the western region of Nepal

Abstract

Snake bite poisoning is an emergency condition with significant morbidity and mortality. It is more prevalent in Terai and Inner Terai regions of Nepal especially during monsoon season. There is no study on snake bite poisoning in adults in this part of the country after the introduction of national snake bite management guideline in 2003. This retrospective study was conducted to evaluate the clinico-epidemiological profile, amount of anti-snake venom used and outcome of snake bites. Six hundred and thirty eight cases of snake bite poisoning above the age of 15 years admitted in emergency department of the hospital, over a period of 6 years from 2004/2005 to 2009/2010 were evaluated retrospectively. The study showed almost equal numbers of bites in males and females (50.3% vs 49.7%) with two third of victims of 15 to 45 years of age. Most of the poisonings (68%) was seen during June, July and August months corresponding to the monsoon season in Nepal. Majority of the victims could not identify the snakes (45 %).Fingers & hands were bitten in majority cases (43 %). Ptosis was observed in all cases of snake bite poisoning. About 21% of the adults had respiratory distress needing respiratory support. Average ASV used was 21.3 vials. Case fatality rate (CFR) was 11.9% with more fatality on those with respiratory distress. As mortality due to snakebite poisoning and consumption of antisnake venom is still high with the use of national protocol 2003, further study to evaluate alternate protocol is recommended.

Study of Clinical Profile of Snake Bite

“…It is difficult to know the actual number of morbidity and mortality of snake bites as these events are not systematically reported in most countries and very few countries possess a reliable epidemiological reporting system. 5 In our study also we could not get exact rate of mortality as follow up was not done of patients referred to tertiary care.…”

A prospective study on clinico-epidemiological profile and outcome in management of poisonous snake bite

“…In Nepal it is estimated that at least 1000 death occurs due to snake bite in Terai region each year. 9 Out of 81 patients, inside home and outside shows almost similar number of snake bite.…”

“…Other studies also reported similar type of observations. 9,10 This may be due to (15-45) years age group is the most active in various outdoor an indoor occupation.…”

“…This finding was similar to other study. 3,7,9,14 Dwelling conditions in rural areas of Nepal is more favorable for habitation of snakes and most people are engaged in agriculture work, which leads to more snake bites. Most patients visited are from Terai regions (84%) compared to hilly regions (16%).…”

“…7 The commonest clinical features in the other study was ptosis as it was takes as the gold standard for the confirmation of poisonous neurotoxic bite and start of anti-snake venom. 9 Out of 81 patients 39 patients were treated with 20-29 vials of ASV and 1 patient was treated with more than 50 vials of ASV. The average number of vials used in each patient was 28±10.…”