title: Severe snakebites in northern KwaZulu-Natal: treatment modalities and outcomes.
abstract: OBJECTIVE
  We aimed to study the outcomes of severe snakebites in patients admitted to Ngwelezana Hospital in north-eastern KwaZulu-Natal, the seasonal variations, and the effectiveness and complications of antivenom.
  
  
  METHODS
  A prospective observational outcomes study was conducted over one year (1 June 2007 to 31 May 2008). The study group was from the north-eastern KwaZulu-Natal region of South Africa, with a population of approximately 3 million people, and included all patients bitten by snakes and admitted to the Ngwelezana Hospital Emergency Medicine Unit (EMU). Departmental practice guidelines were documented and followed.
  
  
  METHODS
  End-points for patient outcomes included transfer from the EMU to the ward, discharge home from the EMU, and follow-up of patients who required surgery or ICU care.
  
  
  RESULTS
  A total of 243 snakebite patients were recorded. The highest incidence was in the summer months; 46 (18.93%) patients experienced one or more severe complications; 29 (11.93%) patients received some form of definitive management in hospital; and 22 (9.05%) of the latter patients received antivenom. Antivenom was administered to more children than adults. Adverse reactions to antivenom were common: an allergic response occurred in 4 (15.4%) patients, and anaphylaxis in 6 (23.1%); the highest incidence occurred in the <10-year-old age group. No deaths were recorded.
  
  
  CONCLUSIONS
  Snakebites are common in the summer months in north eastern KwaZulu-Natal. Children are particularly vulnerable to snakebites and the effects of antivenom. Adverse reactions to antivenom are common. Severe snakebites that require antivenom should be managed in a hospital setting with advanced airway support. The syndromic approach to treatment is simple and effective.
authors.affiliation: Ngwelezane Hospital, Empangeni, KwaZulu-Natal. darryl.wood@kznhealth.gov.za
authors.forename: Darryl
authors.initials: D
authors.lastname: Wood
authors.forename: Caroline
authors.initials: C
authors.lastname: Webb
authors.forename: Jenine
authors.initials: J
authors.lastname: DeMeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000818:Animals; D000997:Antivenins / Q000009:adverse effects* / Q000276:immunology*; D002648:Child; D002675:Child, Preschool; D003161:Compartment Syndromes / Q000453:epidemiology / Q000209:etiology; D017815:Elapidae; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology*; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012621:Seasons; D012909:Snake Bites / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D013019:South Africa / Q000453:epidemiology; D017819:Viperidae; D055815:Young Adult
chemical_list: D000997:Antivenins