Vol 4 | Issue 3 | 2014 | 148-151.

ISSN 2249 - 7641

Print ISSN 2249 - 765X

International Journal of Pharmacology Research

www.ijprjournal.org

INCIDENCE OF SNAKE BITE AND USE OF ANTISNAKE VENOM IN

THE ICU OF TERTIARY CARE HOSPITAL
A CLINICAL RETROSPECTIVE ANALYTICAL STUDY
K. Bhuvaneswari1* and V. Ramya2
1
Professor and Head, Dept of Pharmacology, PSGIMSR, 2Former MBBS student, PSG Institute of Medical Sciences & research,
Peelamedu, Coimbatore, Tamil Nadu, India- 641004.

ABSTRACT
Snakebite is one of the non medico legal emergencies of all Medical emergency departments. This condition can be
observed in all age groups especially those who are living or working in village and few from urban areas also. Anti snake
venom is a life saving drug to antagonize the ill effects of the toxin. Even though it’s in the part of emergency care, still this
can cause ADR and should be treated properly to save the person. Knowledge about the different anti snake venoms,
availability, selection based on the variety of poison, route is very important in emergency care. This study definitely helps
emergency care physicians to equip the department and get ready with the measures to counter ADR associated with anti
snake venom use.

Keywords: Snake bite, Anti-snake Venom, Adverse Drug Reactions.

INTRODUCTION
Snake bite is an important and serious medico-
legal problem in many parts of the world, especially in
south Asian countries. It has been estimated that 5 million
snake-bite cases occur worldwide every year, causing about
1, 00,000 deaths. On an average, nearly 2, 00,000 persons
fall prey to snake-bite per year in India and 35,000-50,000
of them die every year [1].
Snakes most commonly associated with human
mortality in India are cobra (Naja naja), krait (Bungarus
caeruleus), Russels viper (Vipera russelli) and saw scaled
viper (echis carinatus). Snake venoms can prevent many of
these complications if given in time [2]. Snake venom
antiserum is a refined and concertrated preparation of
serum globulins obtained by fractionating blood from
healthy hyperimmunised horses and each ml of which
neutralizes certain quantity of standard venoms tested in
mice by intravenous route.
The anti snakevenom (ASV) usually available in
India is polyvalent. Adverse drug reactions of ASV are
under reported worldwide and the expensive nature of ASV
also delays the treatment. Therefore the present study is to
study the adverse drug reactions and cost effectiveness of
ASV in PSG tertiary care hospital using the patient hospital
records.
OBJECTIVES
1. To describe the demographics and ASV use in PSG
tertiary care hospital.
2. To study the adverse drug reactions and cost
effectiveness of ASV with patients who had been treated in
PSG hospitals.
TYPE OF STUDY: Retrospective analysis of hospital
patient health records who had been diagnosed as poisoning
with snake bite and treated.
PERIOD: Between 1st January 2006 to 31st December 2006
After proper institutional human ethics committee
approval, data’s were collected using a preformed proforma
which contains includes age, sex, bite location (anatomical

Corresponding Author:- K .Bhuvaneswari EMail ID: nandabhuvana@gmail.com

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site), type of snake bite symptoms, total dose of ASV used, b) Administration and adverse reactions of ASV are shown
adverse drug reactions to ASV, concomitant drugs used and in the Table: 1.
cost effectiveness of ASV.
DISCUSSION
RESULTS In this study total no of patients reported with
Shown in figures and tables Incidence of snake bite were 32 in Coimbatore its
Result I surrounding areas. Envenomation to humans may occur
a) Age & Sex Distribution in Snake Bite Patients (Fig-1a) through unintentional interactions or more commonly due
b) Seasonal Influence in Snakebite cases (Fib-1b) to intentional encounters with snakes while handling and
milking venom. It was reported earlier that 82% of the
Result II snake bites are noted among the rural population who were
a) Type of Snake Bite with Symptoms. bitten in agricultural fields while working and also during
Cause of sleeping outdoors. During history taking most patients were
Symptoms
symptom unable to tell the snake species either due to ignorance or
Gum bleed, haematemesis, poor visibility during night (result: 2)
Viper bite haematuria, oliguria, and vaginal In the present work, snake bite cases are observed
bleeding in all age groups between 2yrs-70yrs. The majority being
males in the age group of 21-50yrs. The male female ratio
Dizziness, decreased urine output, in the total number of cases is 1.5:1 showing male
pain, swelling, vomiting Only with preponderance (result: 1) (Fig Ia). Previous studies from
Unknown species
pain, bleeding at the bite site and other countries also show male predominance [3, 4] and
found to have no envenomation indicate increased outdoor activity in male.
b) Incidence and total number of cases reported with Highest Incidence of snake bite recorded during
species specificity (Fig 2) October which was a rainy season in Coimbatore. There
were also evidences that most of the snake bites recorded in
Result III: ASV use rainy season is similar to present study recorded earlier
a) COMPOSITION OF ASV: from Puducherry [5] and Andhra Pradesh [1]. The possible
Snake venom antiserum (POLYVALENT) from reason for majority of the snake bites during rainy season
BHARAT SERUMS AND VACCINES LIMITED is used may be attributed to search for prey like rats and frogs in
in PSG tertiary care Hospital for the treatment of snakebite the dwelling places of people due to flooding of the rain
cases. Each ml of which neutralizes not less than the water and as a result human beings become victim to snake
following quantities of standard venoms tested in mice by bite.
intravenous route. ASV is the mainstay of prevention of
Snake venom Composition complications should be administered as early as possible
Cobra (Naja-naja) 0.6mg or within six hours of snake bite & ASV administered in
Common Krait (Bungarus PSG tertiary care hospital is Polyvalent from Bharat
0.45mg polyvalent. However, Monovalent ASV is superior,
caeruleus)
Russels Viper (Vipera russelli) 0.6mg provided the exact poisonous snake bite and the persons
with non poisonous snake showing no symptoms of
Saw Scaled Viper (Echis carinatus) 0.45mg
envenomation are not given ASV. Some people did not
Cresol (preservative) 0.25%v/v
accept ASV treatment as they cannot afford for ASV and
b) Mode of administration
went untreated (Fig-3). ASV found to be expensive (Table
IV infusion after dilution with 500ml of NaCI or 5%
-1) & Hypersensivity reactions however rare are also noted
dextrose injection and administered as rapidly as tolerated
in the present study. 83.3% of patients accepted ASV were
over 1-2hrs.
does not show any adverse reactions and recovered
c) Incidence of poisonous snakebite and Number of Patients
completely. 12.5% of patients including a pregnant female
Accepted ASV Administration (Fig:3)
complete evacuvation of foetus has occurred. 4.17% of
d) ASV administration Depending on the type of snake bite
patients died of snake bite and death may or may not be due
and percentage of patients Accepted ASV (Fig:4)
to ASV administration (Fig -6). In the present study 4.17%
e) Number of Vials Administered in % of Snake Bite
of patients developed Angioneurotic edema. (Table – 1).
Cases: (Fig: 5)
Previous studies showed that Polyvalent ASV is associated
Result IV:
with severe allergic reactions like anaphylaxis, death and no
Cost Effectiveness of ASV: (Fig-7)
other clinical expressions like non cardiogenic pulmonary
Result V:
edema were noted in hospital records [6].
a) Effects of ASV after Snake Bite (Fig-6)

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Table 1. Adverse Reactions of ASV

Type of No. of ASV
Age Sex Complaints Adverse effects Treatment Given
snake bite vials given
Unknown 19 Pregnant Pain at bite site Complete expulsion Stoppage of ASV
5
Snake bite yrs female vomiting of 20 weeks fetus administration
Unknown 50 Pain, swelling,
Male 5 Allergic reactions Adrenaline, Hydrocortisone
Snake bite yrs fang marks.
Pain, swelling,
Unknown 47
Male Oliguria, Fang 8 Angioneurotic edema Adrenaline, Hydrocortisone
Snake bite yrs
marks
Pain, swelling,
Died.* Death due to
Restlessness
22 snake bite, Renal
Viper bite Male Disoriented, 34 ASV given with Dialysis,
yrs failure, Cellulitis,
Hematuria,
Septicemia, DIC.
Oliguria
* May or may not be due to ASV administration.

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Fig 7. Cost Effectiveness of ASV

DISCUSSION
This study showed increased incidence of snake
bite areas where agricultural activities are more common.
The main limiting aspect of treatment is expensive nature
of ASV and many patients are purely depends on the
government tertiary care hospitals and sometimes losing
their life while traveling a long distance. Hence I would
like to suggest that, Government can provide these
medicines free of cost or at least at very low price level to
patients, so that they can undergo treatment in private
sectors and this will reduce the unnecessary complications
related to snake bite in human beings.
A national network system to be available for
tertiary care hospitals, to cross check ADR related to ASV
and treatment related queries to improve the healthcare
system and also the quality of life of the public of India.
CONCULSION
Snake bites are common mode of poisoning seen
in patients in patients in and around Coimbatore and
constitute 20% of PSG tertiary care hospital admission in
poisoning units.In this study ASV shown its own adverse
effects and test dose should be given before ASV
administrations in all patients. ASV found to be unsafe in
pregnancy. In this work also found that educating the
people about the first aid measure, importance of ASV
administration, hazards of snake bite, the delay in the
treatment of snake bites and various complications mainly
to avoid mortality. ASV is not cheaper and many people
cannot afford the treatment.
ACKNOWLEDGEMENT
This study was financially supported by STS -
ICMR. We express our sincere thanks to the Head of the
department of Emergency Medicine and the Medical
Director of the PSG Hospitals Coimbatore for their
immense support to complete the study.

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2. Kasi visweswaran R and Jacob George. Snake Bite induced acute renal failure. Indian Journal of Nephrology, 9(4), 1999,
156-159.
3. Kulakarni ML, Anees S. Snake venom poisoning: experience with 633 cases. Indian Journal of Paediatrics, 31, 1994, 1239-
43.
4. Rano M. A study of snake bites cases. Journal of Pakistan Medical Association, 44, 1994, 289.
5. Srihari PLD, Rotti SB, Danabalan M, Akshay K. Epidemiological profile of snake bite cases admitted in JIPMER Hospital.
Indian Journal of Community medicine, 26, 2001, 36-8.
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