Empirical use of anti-snake venom in the early morning neuroparalysis

Abstract

Background: Snake bite is a common acute medical emergency, which can present with atypical symptoms in the pediatric age group. Objective: The objective of the present study is to determine the outcome of patients presenting in the early morning with acute onset of atypical symptoms, no history of snake bite or bite marks be considered as a snake bite and treat with anti-snake venom (ASV) and mechanical ventilation. Materials and Methods: The prospective interventional study conducted over a 6 year period between January 2006 and December 2012 at a Rural Health Center in Maharashtra. Results: Out of 41 patients, 28 (68%) were males and 13 (32%) were females with a mean age of 8.59 ± 3.23 and 8.46 ± 2.96 years, respectively. Patients presented between 12 midnight to 7 a.m. with the maximum presentation between 2 a.m. and 4 a.m. (54%). Patients presented with vague complaints such as abdominal pain (60.97%), unconsciousness (17.07%), vomiting (12.19%) and abnormal sensation over body (7.31%) and convulsion (2.43%). All patients were treated with 15 units of ASV and needed mechanical ventilation within 6 h of admission. Duration of ventilation ranged from 36 h to 168 h with and an average of 115 ± 34.753 h. Hospital stay varied from 5 days to 17 days with a mean of 10.892 ± 3.361 days. All patients responded to treatment and there was 1 (2.43%) death owing to the aspiration pneumonitis. Conclusion: Diagnosis of possible snake bite should strongly be considered when patient presents in the early morning with acute onset of atypical symptoms and without any underlying illness, especially krait bite. The study concludes that timely interventions with a bolus dose of ASV and ventilation can de initely save many lives.

Frequency, Presentation, Management and Outcome of Snake Bite in Children at DGKMC & Hospital, D.G Khan.

“…The key to minimizing mortality and morbidity is aggressive management of ABC's of resuscitation, along with timely and judicious administration of ASV. [10][11][12] Although most of the snake bites are reported to be nonpoisonous, however possibility of poisonous envenomation has to be always excluded. Delay in hospitalization is linked with poor prognosis and increased chances of mortality because of consumptive coagulopathy, renal failure and respiratory failure.…”

Role of Adrenaline Premedication in Reducing Anti-Snake Venom Induced Adverse Reactions in Children

“…Children may or may not present with a history of snakebite and have features of snake envenomation like acute descending flaccid weakness of limbs or isolated respiratory difficulty or bleeding manifestations. 1 Administration of anti-snake venom (ASV) is the definitive treatment for venomous snake bites. 2 ASV is an immunoglobulin that is enzyme derived.…”

“…5 A presumptive diagnosis of snake envenomationis undertaken especially in children presenting with krait bites in the early morning hours with respiratory difficulty and unresponsiveness. 1 These children may not have a history of snakebite or any circumstantial evidence of having seen a snake in the vicinity. In such situation's, injection ASV is administrated based on clinical suspicion and there is no definite laboratory test as of now to confirm or rule out snake envenomation.…”