Clinical course and outcome of snake envenomation at a hospital in Karachi

Mahmood K, Naqvi IH, Talib A, Salkeen S, Abbasi B, Akhter T, Iftikhar N, Ali A
Correspondence: Dr Iftikhar Haider Naqvi, driftikharhaider@hotmail.com

ABSTRACT
Introduction Snake envenomation is a frequently reported medical emergency at the Civil Hospital Karachi, Pakistan, thus obviating the need to assess the patterns of the clinical course and outcome of snake envenomation cases.
Methods The demographic characteristics, clinical signs and symptoms, laboratory findings, treatment and outcome of 80 victims of snake bite were recorded. These patients were admitted to the Civil Hospital Karachi between January 2006 and September 2007. The data of all the cases was analysed statistically using the Statistical Package for the Social Sciences version 11.0.
Results The majority of the 80 victims of snake bite were male (80 percent) and 20 percent were female. The mean age of the patients was 33.3 years. The main type of envenomation was vasculotoxic (92.5 percent), and none were neurotoxic or myotoxic. Both local and systemic clinical features of envenomation were present. Bleeding was reported in 43.8 percent of the patients. 71.3 percent of the patients showed coagulopathy of defibrination and the anti-coagulant type. All patients received anti-snake venom. Five (6.3 percent) patients in the study died.
Conclusion The most common type of snake envenomation in this part of the province of Sindh is vasculotoxic due to the high inhabitancy of Viperidae. High morbidity and mortality rates can be reduced significantly through patient education on the precautions that need to be taken by farmers and field workers against snake bite. Early referral to a well-equipped health facility is necessary, as the mortality rate was high among those patients who arrived late.

Keywords: activated partial thromboplastin time, anti-snake venom, envenomation, prothrombin time
Singapore Med J 2010; 51(4): 300-305