DOI: http://dx.doi.org/10.18203/2349-3933.ijam20184209

Assessment of clinical parameters among patients with snake poison induced coagulopathy

Hariprasad S., Neha Sukhani

Abstract


Background: Snakes are poikilothermic carnivorous reptiles that have evolved the venomous apparatus for the purpose of procurement of food. Snake bite can result in local and systemic complications. Major systemic complications include acute renal failure, neurologic abnormalities requiring ventilator support and disseminated intravascular coagulation. Disseminated intravascular coagulation can result in serious life-threatening systemic complications like haemorrhage, infarction and even death if the treatment is delayed. The present study was undertaken to study the clinical profile of the snake bite patients who develop coagulopathy and to study the role of coagulation markers to evaluate the morbidity and mortality of snake bite victims.

Methods: Hundred patients consecutively admitted with history of snakebite were studied. Patients who have developed local signs of envenomation due to snake bite were included in the study group. The coagulation profile was assessed by doing blood investigations.

Results: In this study, patients who developed coagulopathy had prolonged hospital stay and requirement of more blood products transfusion causing increased morbidity. 43 patients (35.8%) had platelets less than 1 lakh and approximately hospitalized for 26 days sand INR was more than 1.5 in 112 patients (93.3%) and hospitalized for 22 days and they received fresh frozen plasma. The survival rate in this study was 86% followed by 13.3% deaths.

Conclusions: Use of clinical and laboratory parameter evaluation needed to identify the coagulopathy very early to reduce the hospital stay and mortality.


Keywords


Coagulopathy, INR, PT, Snake bite, WBCT

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References


Warrell DA. Guidelines for the management of snake bites. In: World Health Organization, Regional Office for Southern East Asia. 2010:1-162.

World Health Organization. Zoonotic disease control: baseline epidemiological study on snake-bite treatment and management. Weekly Epidemiological Record. 1987;62(42):319-20.

Bick RL. Disseminated intravascular coagulation, current concepts of etiology, pathophysiology, diagnosis, and treatment. Hematol Oncol Clin North Am. 2003;17:149-76.

Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, et al. Clinical predictors of inā€hospital mortality in patients with snake bite: a retrospective study from a rural hospital in central India. Tropical Med Int Health. 2006 Jan;11(1):22-30.

Sgrignolli LR, Mendes GE, Carlos CP, Burdmann EA. Acute kidney injury caused by Bothrops snake venom. Nephron Clin Practice. 2011;119(2):c131-7.

Lokesh NK, Anikethan GV, Manju B. Clinico-epidemiological profile of patients who have consumed poison and reported to MIMS Government Hospital in Mandya Pradesh. Int J Contemporary Med Res. 2018;5(6):5-7.

Adhisivam B, Mahadevan S. Snakebite envenomation in India: a rural medical emergency. Indian Pediatr. 2006 Jun 1;43(6):553.

Gold BS, Dart RC, Barish RA. Bites of venomous snakes. N Eng J Med. 2002 Aug 1;347(5):347-56.

Bawaskar HS, Bawaskar PH. Profile of snakebite envenoming in western Maharashtra, India. Transactions Royal Soc Trop Med Hygiene. 2002 Feb 1;96(1):79-84.

Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emergency Med J. 2005 Feb 1;22(2):118-20.

Aundhakar Swati C, Mandade Arjun D, Afzalpurkar Shiva R, Prajapati Piyush K. A rare snake bite sequelae: intracerebral haemorrhage with cerebellar infarction. J Contemporary Med Res. 2017;4(10):2057-9.

Ramesha KN, Rao KB, Kumar GS. Pattern and outcome of acute poisoning cases in a tertiary care hospital in Karnataka, India. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Soc Critical Care Medi. 2009 Jul;13(3):152.

Das SK, Raju AS, Mohanty MK, Patnaik KK, Mohanty S. Sociodemographic profile of poisoning cases. JIAFM. 2005;27(3):133-8.

Thomas M, Anandan S, Kuruvilla PJ, Singh PR, David S. Profile of hospital admissions following acute poisoning- experiences from a major teaching hospital in south India. Adverse Drug React Toxicol Reviews. 2000 Dec;19(4):313-7.

Shiau DT, Sanders JW, Putnam SD, Buff A, Beasley W, Tribble DR, et al. Self-reported incidence of snake, spider, and scorpion encounters among deployed US military in Iraq Afghanistan. Military Med. 2007 Oct 1;172(10):1099-102.

Harshavardhana H, Pasha I, Prabhu N, Amira RP. Snake bite induced coagulopathy: a study of clinical profile and predictors of poor outcome. Int J Sci Study. 2014;2:2-5.

Lingayat AM, Wankhade PR. Study of clinical profile complications and outcome in patients of snake bite in pediatric age group. Int J Healthcare Biomed Res. 2015 Apr;3(3):203-8.

Banerjee RN. Poisonous snakes of India, their venoms, symptomatology and treatment of envenomation. Progress Clin Med India. 1978;2:136-79.

Biradar MV, Abhange R. A study of laboratory parameters prothrombin time and 20 minute WBCT in snake bite patients. MedPulse - Int Medi October J. 2015;2(10):697-701.

Ishfaq A, Maqbool F, Toor HS, Ahmed SI. Hematotoxicity in patients with Snake Bite. J Rawalpindi Med Coll (JRMC). 2014;18(1):20-2.

Paul J, Dasgupta S. Early prediction of acute kidney injury by clinical features of snakebite patients at the time of hospital admission. North American J Med Sci. 2012 May;4(5):216.

Karunanayake RK, Dissanayake DMR, Karunanayake AL. A study of snake bite among children presenting to a paediatric ward in the main Teaching Hospital of North Central Province of Sri Lanka. BMC Res Notes. 2014;7:1-6.