See discussions, stats, and author profiles for this publication at: [Link]
net/publication/261375218
Snake bite poisoning: A neglected life-threatening occupational hazard
Article in Indian Journal of Critical Care Medicine · March 2014
DOI: 10.4103/0972-5229.128698 · Source: PubMed
CITATIONS READS
3 119
1 author:
Himmatrao Bawaskar
Bawaskar Hospital
99 PUBLICATIONS 1,615 CITATIONS
SEE PROFILE
All content following this page was uploaded by Himmatrao Bawaskar on 22 June 2014.
The user has requested enhancement of the downloaded file.
[Downloaded free from [Link]
Editorial
Snake bite poisoning: A neglected life-threatening
occupational hazard
Himmatrao Saluba Bawaskar
In India in 2005, 46,000 people died of snake bite which is Access this article online
one for every 2 human immunodeficiency virus/acquired Website: [Link]
immunodeficiency syndrome deaths.[1] Still the money, DOI: 10.4103/0972-5229.128698
energy, scientific and research time allotted to snake Quick Response Code:
bite is negligible. Snake bite is a time limiting acute
life-threatening medical emergency often faced by
farmers, villagers, hunters, migrating population and
and those in poor living conditions such as in huts and
small dwelling places in the hills. Snake bite is one of
the most important and neglected diseases of tropical
and subtropical regions. Young earning members, active
workers, farmers are the main victims. Maximum cases
are reported when farmers, villagers are busy in farming.
Maximum viper bites are reported during the day and serum (10 vials) a 20 minute whole blood clotting test
early darkness in the months of November to April, (20 WBCT) should be done. As the baseline test may
although krait bite is frequent during June to November. not show coagulation abnormalities, this test should
Recently incidence of snake bite is rise because of >12 h be repeated 6 hours after the last dose of the anti-snake
electricity load shading.[2] venom (ASV). This would help decide repeat dose of
ASV (50 ml). Along with diuretics, acetyl cysteine may
The Big fours, namely, the haematotoxic (Russell’s also help to arrest the rapid progression of swelling of
viper, Echis carinatus), and the neurotoxic (bungareus the limb and subsequent amputation and renal failure
caeruleus krait and Naja naja-cobra) are the common due to compartment syndrome.
venomous snakes that flourish all over India. However a
few region-specific species such as the black cobra, green The E. carinatus is most aggressive and soon after a bite
pit viper, hope nosed viper and as in the present paper it rapidly runs away and many a time victims attribute
of Raina et al. reported Trimeresurus albolabris (white the gradual swelling to usual injury which prevent
lipped pit viper) and Gloydius himalayanus pit vipers) the administration of ASV and such victims later go
are reported.[3] on to develop progressive swelling, compartment
syndrome, septicemia, renal failure and disability.
Clinical manifestations are almost similar except a Thus farmers while walking amongst tall grass-lands
few regional variation. Russells viper envenoming may or in early darkness may get rapidly progressive limb
result in neuroparalysis in the hills of Himachal Pradesh swelling with regional lymphadenopathy with or
and Kochi areas.[3] Prior to treating envenomation by without history of snake bite in such contexts a viper
Russell's viper with sufficient amount of polyvalent bite should be diagnosed unless proved otherwise.
Thus in viper bite progressive local swelling with early
regional lymphadenopathy suggestive of systemic
From: envenoming. At this time, blood may clot within 20 min.
Bawaskar Hospital and Research Center, Mahad, Raigad, Maharashtra, India
Hypotension, shock and capillary leaks in Russell’s
Correspondence: viper is attributed bradykinin content of venom.
Dr. Himmatrao Saluba Bawaskar, Bawaskar Hospital and Research Center,
Mahad, Raigad - 402 301, Maharashtra, India.
Haemorrhage in the adrenals and the pituitary gland
E-mail: himmatbawaskar@[Link] need to be managed with appropriate doses of methyl
123
[Downloaded free from [Link]
Indian Journal of Critical Care Medicine March 2014 Vol 18 Issue 3
prednisolone, and fluids. In the long-term secondary and (Echis + Russell’s viper) preparation may reduce
amenorrhea and Sheehan’s syndrome in victims of the total dose requirements. Venom detection kit
Russell’s; viper have been bite reported from India.[4] may arrest the use of excessive ASV. There should be
Cobra bite is often reported while handling rubbers, regional venom and antivenom bank for specific ASV
debris or blindly putting hand in grooves, blindly for species of snake found in the respective regions.
handling old objects in attics. Majority of victims die
suddenly due to lethal ventricular arrhythmias from the Prevention is the mother of cure. Proper use of
threat of death accompanied by a surge of endogenous mosquito net tagged nicely to floor bedding with
catecholamine is not seen in children. Sudden onset of bamboo cot may prevent krait, scorpion, and mosquito
cardiogenic shock, heart block or respiratory arrest can bites alike.[2] Thick rubber gum shoes and hand gloves
be revived by timely resuscitation, ASV and artificial may prevent viper bite. No rubble, firewood, cattle’s
ventilation by mouth-to mouth breathing on the spot or hens cages should be near the human dwellings.
and by bag and mask at medical centers. Venom is There should be routine training to medical students
rich in myotoxin and phospholipids which destroy regarding endotracheal intubation, and examinations
the tissues. Therefore, huge non-healing wound or should include questions on snake envenomation and
ulcers may subsequently need plastic surgery or skin identification of common snakes. Primary health centers
grafting. The authors of the present article mention should be well-equipped with enough quantity of ASV,
early morning neuroparlysis as nothing but a victim of emergencys, endotracheal tubes, working laryngoscopes,
krait bite.[3,5] Krait is a nocturnal snake. Its fang size is Ambu bags and ventilators.
like that of an insulin needle. It enters the house during
the night. While hunting rats, lizards and small kraits it Snake bite is an occupational hazard. No
may enter in to the bedding which may result in a snake stone should be left unturned (medical facilities,
bite. Due to the small size venom injected only skin deep ambulances and money) to save the sons of the soil. ASV
by small fangs, there may be no signs or symptoms at for hope nosed viper, green pit viper, sea snake is not
the site of bite. Within 30 min of the bite the victims available in India however the para specificity properties
experience abdominal colic and vomiting due to release of available ASV may be helpful.
of acetyl choline and cholestokinine. The victim may
experience tingling numbness or heaviness iaffecting Scientists should make attempts to find alternatives to
the limb. By the time the victim reaches hospital he ASV as we found prazosin for the management of severe
may manifest full-fledged neuroparalysis or locked in scorpion sting.[6]
syndrome with absent of deep tendon reflexes. Many
times krait bite victims are wrongly diagnosed as References
appendicitis, stroke, Guillain-Barré syndrome, hysteria, 1. Warrell DA. Snake bite: A neglected problem in twenty-first century
acute abdomen, botulism and undergo unnecessary India. Natl Med J India 2011;24:321-4.
surgical intervention and investigations such as brain 2. Bawaskar HS, Bawaskar PH, Punde DP, Inamdar MK, Dongare RB,
Bhoite RR. Profile of snakebite envenoming in rural Maharashtra,
computed tomography, magnetic resonance imaging, India. J Assoc Physicians India 2008;56:88-95.
lumber puncture etc. 3. Raina R, Raina S,Kaul R,Chander V,Jaryal A. Snakebite profile from a
medical college in rural setting in the hills of Himachal Pradesh, India
Indian J Crit Care Med 2014:18;130-4.
In India, there is always a short supply of ASV. 4. Uberoi HS, Achuthan AC, Kasthuri AS, Kolhe VS, Rao KR, Dugal JS.
Medical officers are untrained and usually have Hypopituitarism following snake bite. J Assoc Physicians India
1991;39:579-80.
never examined or managed a snake bite case before.
5. Bawaskar HS, Bawaskar PH. Envenoming by the common
Envenoming is, and not the merely a history of krait (Bungarus caeruleus) and Asian cobra (Naja naja): Clinical
snake bite is the indication for ASV. 20 WBCT test manifestations and their management in a rural setting. Wilderness
Environ Med 2004;15:257-66.
help re-administration of ASV. Any amount of ASV
6. Bawaskar HS, Bawaskar PH. Call for global snake-bite control and
will not neutralize the venom once it is attached to procurement funding. Lancet 2001;357:1132-3.
neuromuscular junctions, platelets, red blood cells,
renal tissues, endothelial cell, voluntary muscles (sea
snake). To reduce the crisis of ASV supply medical
officers should be given training regarding dose How to cite this article: Bawaskar HS. Snake bite poisoning: A neglected
and indication of ASV. Bivalent ASV (krait + cobra) life-threatening occupational hazard. Indian J Crit Care Med 2014;18:123-4.
124
View publication stats