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A season of snakebite envenomation: presentation patterns, timing of care,
anti-venom use, and case fatality rates from a hospital of southcentral Nepal
#MMPMID26998219
Pandey DP
; Vohra R
; Stalcup P
; Shrestha BR
J Venom Res
2016[]; 7
(?): 1-9
PMID26998219
show ga
Snakebite envenomation affects thousands of people annually in Nepal. Published
hospital-based studies of snakebite treatment in Nepal are scarce. Here we
present the results of the first prospective, cross-sectional study of
hospitalized envenomed snakebite cases in southcentral Nepal, a region
characterized by poor pre-hospital care of snakebites, limited supply and
excessive use of antivenom, and a high case/fatality ratio. We seek to identify
clinical management problems and suggest potential interventions to improve
treatment of snakebites. Out of the 342 patients presented with snakebites to an
urban emergency department in the Terai region of Nepal between April and
September of 2007, 39 patients were enrolled based on development of ptosis or
swelling of bitten body parts. We collected patient demographic information and
documented circumstances of snakebite, prehospital care, hospital care, and
development of complications. Among 39 envenomated patients admitted to Bharatpur
Hospital enrolled in the study 34 (92%) exhibited features of clinically
significant neurotoxicity and were treated with antivenom. Antivenom use ranged
from 4 to 98 vials of Polyspecific Indian Antivenom per patient. Each of victims
(n=34) received antivenom an average of 4.3 (median) ±0.73 (standard error of
mean) hours after receiving the snakebite. The overall case fatality rate was
21%. Neurotoxicity developed up to 25.8hr after suspected elapid snakebites. This
was not observed for viperid snake bites. No enrolled patients received any of
the currently recommended first aid for snake bite. The prevalence of nocturnal
elapid snake bites, the practice of inappropriate first aid measures and highly
variable administration of antivenom were identified as major challenges to
appropriate care in this study. To address these issues we suggest development of
a comprehensive checklist for identification of snake species, management of
envenomation, and an educational program which teaches proper care at all stages
of snakebite treatment.
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