Spectrum of snake bites and short term outcomes of snake envenomation: experience of a tertiary care center in eastern india

Background: Snake envenomation is global health problem particularly in tropics. Few data exist regarding overall spectrum of snake bites and the outcomes of snake envenomation from eastern India.
Materials and methods: Objective: to observe and analyze the various presentations of snake bite cases and to study the short term outcomes of complications of snake envenomation.
Design and Participants: Single center prospective observational study of snake bite cases admitted at a tertiary health care center from June 2013 to May 2014. All patients more than 18 years of age, admitted with snake bite in R.G.Kar Medical College during this period were included. Outcome: 1)Complete recovery: no residual organ dysfunction; 2)Partial recovery: no dialysis dependence, improved renal function at discharge but not to baseline level at the time of discharge; 3)dialysis dependent at discharge; 4)Death.
Results: Total 74 cases were enrolled. Majority of cases presented to hospital between 0-6 hours of bite (63.52%). Non-poisonous snake bites (n=26, 35.13%) were more common than poisonous snake bites (n=48, 64.87%). Neurological manifestations were seen in 9 (34.61%) and AKI was seen in 11 (42.30%) out of the 26 poisonous snake bite cases. Most cases of AKI were in stage 3 or RIFLE -F stage at diagnosis. Cellulitis and regional lymphadenopathy were associated with AKI significantly (p values of 0.000 and 0.002 respectively). All neurotoxic envenomation cases had complete recovery at discharge. Of these 2 (22.22%) cases were complicated by sepsis. Outcome of AKI patients was relatively poor, with complete recovery on discharge was seen in 5 (45.45%), partial recovery without dialysis dependence in 4 (36.36%) and dialysis dependence in 1(9.09%) of the cases. 1death occurred in AKI with sepsis group.
Conclusion: Neurotoxic envenomation generally have good prognosis if managed early. Vasculotoxic envenomation, however is portends poorer prognosis with complete recovery in less than half cases.