EFFECTS OF HEMOTOXIC SNAKE BITE ENVENOMATION ON HAEMATOLOGICAL PARAMETERS VARIABILITY IN PREDICTING COMPLICATIONS
Keywords:hemotoxic snake bite, acute kidney injury, shock, clotting time, bleeding time
Background. Snake bite envenomation is a major public health problem in India with a high mortality rate. The major complications following a hemotoxic snake bite are disseminated intravascular coagulation (DIC), shock, acute kidney injury (AKI), acute respiratory distress syndrome (ARDS) and coagulopathy. The study explores a possible correlation of the haematological parameters studied to complications like DIC, AKI, acute renal failure (ARF), ARDS, shock and gastrointestinal (GI) bleed.
Objective. The aim of the study was to find out the effect of snakebite envenomation on the major haematological parameters of the body in relation to complications.
Methods. This cross-sectional study was conducted during a period of 18 months. 150 patients were included in the study after obtaining their informed consents. Data collection was done using a proforma. The study also compared clotting time (CT) by capillary tube method and whole blood clotting time at 20 minutes (WBCT20). SPSS software was used for statistical analysis.
Results. Among the people with complications, the majority (52%) of participants had AKI, 26% of them requiring dialysis, 16.7% participants had GI bleed, 11.3% participants had shock and 10% participants had DIC.
Conclusions. A prolonged bleeding time was found to be one of the most helpful haematological parameters in predicting shock and AKI. Clotting time by both capillary tube and WBCT20 methods were comparable in predicting complications.
Objective: The objective of this study was to find the effect of snakebite envenomation on the major haematological parameters of the body.
Material and method: This cross-sectional study was conducted over a period of 18months. A total of 150 patients were included in the study after obtaining informed consent. Data collection was done using a proforma. SPSS software was used for statistical analysis.
Results: Among the people with complications, the majority (52%) of participants had AKI, followed by 26% participants who required Dialysis, 16.7% participants had GI bleed, 11.3% participants had the shock and 10% participants had DIC.
Conclusion: A prolonged bleeding time was found to be one of the most helpful haematological parameters in predicting the shock and AKI.
Dandona R, Kumar GA, Kharyal A, George S, Akbar M, Dandona L. Mortality due to snakebite and other venomous animals in the Indian state of Bihar: Findings from a representative mortality study. PLoS One 2018;13:e0198900.
DOI: https://doi.org/10.1371/journal.pone. 0198900.
Kasturiratne A, Wickremasinghe AR, De Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: A literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008;5:1591–604.
DOI: https://doi.org/10.1371/journal.pmed. 0050218.
Menon JC, Joseph JK. Complications of hemotoxic snakebite in India. Toxinology Clin Toxinology Asia Pacific Africa 2015;35:209–32.
Kasturiratne A, Wickremasinghe AR, de Silva NG, NK, Pathmeswaran A, Premaratna R, Savioli L, Lalloo DG D, HJ. S. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008;5:e218.
Menon J, Joseph JK, Kulkarni K. Treatment of snakebites – a resumé. Cobra 2007;1:1–21.
Chippaux JP. Snake-bites: Appraisal of the global situation. Bull World Health Organ 1998;76: 515–24.
Lavonas EJ, Gerardo CJ, O’Malley G, Arnold TC, Bush SP, Banner W, et al. Initial Experience with Crotalidae Polyvalent Immune Fab (Ovine) Antivenom in the Treatment of Copperhead Snakebite. Ann Emerg Med 2004;43:200–6.
DOI: https://doi.org/10.1016/j.annemergmed. 2003.08.009.
Yin S, Kokko J, Lavonas E, Mlynarchek S, Bogdan G, Schaeffer T. Factors associated with difficulty achieving initial control with Crotalidae polyvalent immune fab antivenom in snakebite patients. Acad Emerg Med 2011;18:46–52.
Gerardo CJ, Evans CS, Kuchibhatla M, Drake WG, Mando-Vandrick JD, Yen M, et al. Time to Antivenom Administration in Snakebite. Ann Emerg Med 2013; 62:S44.
Lavonas EJ, Kerns WP, Gerardo CJ, Richardson W, Whitlow K, Berkoff DJ. 328: Long-Term Limb Function Outcomes Following Copperhead Snakebite. Ann Emerg Med 2008;52:S141–2.
Thorson A, Lavonas EJ, Rouse AM, Kerns WP. Copperhead envenomations in the Carolinas. J Toxicol - Clin Toxicol 2003;41:29–35.
Knudsen C, Laustsen AH. Recent advances in next generation snakebite antivenoms. Trop Med Infect Dis 2018;3.
Kanjanabuch T, Sitprija V. Snakebite Nephrotoxicity in Asia. Semin Nephrol 2008;28:363–72.
DOI: https://doi.org/10.1016/j.semnephrol. 2008.04.005.
Chugh KS. Snake-bite-induced acute renal failure in India. Kidney Int 1989;35:891–907.
Greene S, Bush SP. What percentage of snake species are venomous? Medscape 2020.
https://www.medscape.com/answers/168828-39085/what-percentage-of-snake-species-are-venomou (accessed March 18, 2020).
Ratnayake I, Shihana F, Dissanayake DM, Buckley NA, Maduwage K, Isbister GK. Performance of the 20-minute whole blood clotting test in detecting venom induced consumption coagulopathy from Russell’s viper (Daboia russelii) bites. Thromb Haemost 2017;117:500–7.
Palevsky PM, Liu KD, Brophy PD, Chawla LS, Parikh CR, Thakar CV, et al. KDOQI US commentary on the 2012 KDIGO clinical practice guideline for acute kidney injury. Am J Kidney Dis. 2013;61:649–72.
IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp n.d.
Harshavardhan L, Lokesh AJ, Tejeshwari HL, Halesha BR, Metri SS. A study on the acute kidney injury in snake bite victims in a tertiary care centre. J Clin Diagnostic Res 2013;7:853–6.
DOI: https://doi.org/10.7860/JCDR/2013/ 5495.2957.
Kumar KS, Narayanan S, Udayabhaskaran V, Thulaseedharan NK. Clinical and epidemiologic profile and predictors of outcome of poisonous snake bites - an analysis of 1,500 cases from a tertiary care center in Malabar, North Kerala, India. Int J Gen Med 2018;11:209–16.
Simpson ID, Norris RL. Snakes of medical importance in India: is the concept of the “Big 4” still relevant and useful? Wilderness Environ Med 2007;18:2–9.
Bhalla G, Mhaskar D, Agarwal A. A study of clinical profile of snake bite at a tertiary care centre. Toxicol Int 2014;21:203–8.
Mallow D, Ludwig D NG. True vipers: natural history and toxinology of Old World vipers. vol. 41. Krieger Publishing Company; 2003.
Tun-Pe, Phillips RE, Warrell DA, Moore RA, Tin-Nu-Swe, Myint-Lwin, et al. Acute and chronic pituitary failure resembling Sheehan’s syndrome following bites by Russell’s viper in Burma. Lancet (London, England) 1987;2:763–7.
Fatah C. Pathophysiological and Pharmacological Effects of Snake Venom Components: Molecular Targets. J Clin Toxicol 2014;04.
How to Cite
Copyright (c) 2021 International Journal of Medicine and Medical Research
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who sent their manuscript to International Journal of Medicine and Medical Research agree to the following terms:
1. Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License CC-BY-NC that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
2. Authors able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
3. Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).