title: Clinical profile, species-specific severity grading, and outcome determinants of snake envenomation: An Indian tertiary care hospital-based prospective study.
abstract: OBJECTIVE
  We undertook this study to assess the clinical profile and outcome determinants of different snake envenomation as well as to assign species-specific severity grade to different cases based on clinico - laboratory evidence scale.
  
  
  METHODS
  A prospective clinico - epidemiologic evaluation for outcome determinants of snakebite envenomation was carried out based on a clinico - laboratory severity grading scale, among 76 patients over a period of 2 years, in a tertiary care hospital in southern India.
  
  
  RESULTS
  Majority of patients were male agricultural workers (53.9%) followed by housewives (19.7%), and students (9.2%). Occurrence of viper snake envenomation with hemotoxic syndrome (73.68%) was highest followed by cobra and krait envenomation with neurotoxic (19.73%) and hemo - neurotoxic (5.3%) syndrome, respectively. On the contrary, maximum mortality and severity was seen in krait (60%) followed by cobra (13.33%) and viper (8.9%) envenomation. The average dose of anti-snake venom (ASV) administered varied from 9.83 (±7.22) to 20.25 (±4.92) vials throughout grade I to IV in all snake species envenomation. An increase in severity grade, ASV dose, and mortality were observed with the corresponding delay in 'bite to needle time.' Also, initial traditional treatments and krait species envenomation were significantly associated with higher grades of severity and mortality.
  
  
  CONCLUSIONS
  There is an urgent need to spread awareness among the community for avoidance of traditional treatment and any delay in medical intervention in snakebite incidents.
authors.affiliation: Department of Medicine, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
authors.forename: Kavitha
authors.initials: K
authors.lastname: Saravu
authors.forename: Vasanth
authors.initials: V
authors.lastname: Somavarapu
authors.forename: Ananthkrishna B
authors.initials: AB
authors.lastname: Shastry
authors.forename: Rishikesh
authors.initials: R
authors.lastname: Kumar
keywords: Antivenins; envenomation; ophitoxaemia; severity grade; snakebite
references.citation: PLoS Negl Trop Dis. 2010 Jan 26;4(1):e603
references.pmid: 20126271
references.citation: J Indian Med Assoc. 2009 Jan;107(1):12-3
references.pmid: 19588680
references.citation: J Assoc Physicians India. 2004 Jan;52:14-7
references.pmid: 15633711
references.citation: Southeast Asian J Trop Med Public Health. 1999;30 Suppl 1:1-85
references.pmid: 10983553
references.citation: N Engl J Med. 2002 Aug 1;347(5):347-56
references.pmid: 12151473
references.citation: Lancet. 2010 Jan 2;375(9708):77-88
references.pmid: 20109866
references.citation: Nephrology (Carlton). 2006 Oct;11(5):442-8
references.pmid: 17014559
references.citation: J Ayub Med Coll Abbottabad. 2008 Jul-Sep;20(3):125-7
references.pmid: 19610536
references.citation: J Assoc Physicians India. 2006 Sep;54:717-9
references.pmid: 17212020
references.citation: Toxicon. 2003 Mar 1;41(3):285-9
references.pmid: 12565750
references.citation: Southeast Asian J Trop Med Public Health. 1980 Jun;11(2):285-93
references.pmid: 7434080
references.citation: J Assoc Physicians India. 2004 Jan;52:11-3
references.pmid: 15633710
references.citation: Emerg Med J. 2005 Feb;22(2):118-20
references.pmid: 15662063
references.citation: Med Trop (Mars). 2006 Oct;66(5):423-8
references.pmid: 17201283
references.citation: Indian J Med Res. 2007 May;125(5):661-8
references.pmid: 17642502
references.citation: J Forensic Leg Med. 2011 Jan;18(1):18-20
references.pmid: 21216374
references.citation: Natl Med J India. 2005 Mar-Apr;18(2):71-5
references.pmid: 15981441
references.citation: Am J Trop Med Hyg. 2004 Aug;71(2):234-8
references.pmid: 15306717
references.citation: Indian Pediatr. 2006 Jun;43(6):553-4
references.pmid: 16820669
references.citation: Southeast Asian J Trop Med Public Health. 2005 May;36(3):733-40
references.pmid: 16124448
references.citation: Toxicon. 2008 Aug 1;52(2):221-7
references.pmid: 18590753
references.citation: Ren Fail. 2008;30(1):51-5
references.pmid: 18197543
references.citation: Am J Trop Med Hyg. 1997 Feb;56(2):168-70
references.pmid: 9080875
references.citation: Vaccine. 2009 Feb 11;27(7):1067-72
references.pmid: 19100805
references.citation: PLoS Med. 2006 Jun;3(6):e150
references.pmid: 16729843
references.citation: Curr Pharm Des. 2007;13(28):2935-50
references.pmid: 17979738