Introduction:  Snakebite is a major public health problem throughout the world, more so in tropical and subtropical countries. In India, there are 216 species of snakes, of which only four are venomous snakes (Cobra, Krait, Russell’s Viper and Saw Scaled Viper). Poorly informed rural populations often apply inappropriate first-aid measures and vital time is lost before the victim is transported to a treatment center, where cost of treatment can constitute an additional hurdle.

Materials & Methods: This descriptive observational study was carried out from January 2017 to December 2017, at Department of Medicine in Maharana Bhupal Government Hospital, R.N.T. Medical College, Udaipur, a tertiary care hospital serving population of Southern Rajasthan.

Result: A total of 100 patients with a history of snake bite and signs of envenomation were included in this study. 38(38%) had viper bites, 33(33%) were unidentified and 29(29%) had krait bites. Maximum incidence were in farmers (73%) and in rural areas (82%). Commonest vasculotoxic manifestation was local bleeding (71.42%). Commonest neurotoxic manifestation was ptosis (100%)The mean dose of ASV vials required for vasculotoxic snakebites was more (32.62vials) and for neuroparalytic snakebite was less (10.00 vials).  One patient died because of respiratory paralysis, due to delayed presentation in hospital.

Conclusion: Snake bites are common in rural areas affecting mainly agricultural workers, in rainy season and the most common site is lower limbs. Most poisonous snake bites are due to hematotoxic bites in this region. From this study, it is inferred that delay in presentation following snake bite has an overall negative effect on the outcome and there is no substitute for early and effective treatment with ASV. Population awareness programs regarding prevention, first-aid and the importance of the early transfers to be emphasized.

1. Harrison’s Principles of Internal Medicine; 19th edition: volume 2:2733-38
2. David A Warrell; venomous bite & sting. Manson’s tropical disease; 22nd edition: 560
3. Narayan Reddy K.S.: organic irritant poisons. The essentials of forensic medicine and toxicology.34th edition:523
4. Haiti AK, Mandal M, Mukerjee H, Hati RN. Epidemiology of snake bite in the district of West Bengal. J Indian Med Assoc 1992;145-7
5. Ried HA and Theakston RDG. Bulletin for world Health Organization 61;885-95
6. Warrell DA, Greenwood BM. Necrosis, hemorrhage, and complement depletion following the bites by spitting cobra. J Med 1976;55;1-22
7. Saini RK,Sharma S, Singhs, Pathania NS. Snake bite poisoning: A preliminary report. J Assoc Physicians India. 1984;32:195-7
8. Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a North Indian hospital. Emerg Med J. 2005;22:118–20
9. Virmani SK, Dutt OP. A profile of snake bite poisoning in Jammu region. J Indian Med Assoc.1987;85;132-4
10. Naik RS, Tirpude BH, Khajuria BK. Mortality and morbidity pattern in snake bite at MGIMS Sevagram, Wardha: A rural area. Indian Pract. 1997;50:31–5.
11. Kulkarni ML, Anees S. Snake venom poisoning, experience with 633 patients. Indian Paediatr. 1994;31:1239–43.
12. Punde DP. Management of Snake Bite in rural Maharashtra.A 10 year experience. The national medical journal of India 2005; 18: 71-5
13. Steinmann L, Devkota UN, Shah LN. Snakebite in Nepal: A study from Siraha District. J Nepal Med Assoc. 2000;39:203–9
14. Watt G, Padre L, Tuazon ML, Theakston RD, Laughlin LW. Tourniquet application after cobra bite: Delay in the onset of neurotoxicity and the dangers of sudden release. Am J Trop Med Hyg.1988;38:618-22
15. Sarangi A, Jana I, Das JP.Clinical profile of snake bite poisoning. J Assoc Physicians India.1977;55-60
16. Gaurav Bhalla, Dhanesh Mhaskar, Anubhav Agarwal. A Study of Clinical Profile of Snake Bite at a Tertiary Care Centre; Toxicology International;2014 May-Aug;203-8
17. Seneviratne U, Dissanayayake S. Neurological manifestations of snake bite in Srilanka. J Postgrad Med 2002; 48: 275-8
18. Virendra C. Patil, Harsha V. Patil, Avinash Patil, Vaibhav Agrawal. Clinical profile and outcome of envenomous snake bite at tertiary care centre; Int J Med. Public health; October-December 2011;28-38
19. Omogbai EK, Zuleikha AM, Imhafidon MA, Ikpeme AA, Ojo D, Nwako CN, et al. Snake bites in Nigeria: A study of the prevalence and treatment in Benin City. Trop J Pharm Res. 2002;1:39 44.

Dr Raviraj Singh Ahada

Post-Graduate Resident, Department of Medicine RNT Medical College Udaipur, India