title: A retrospective study of use of polyvalent anti-snake venom and risk factors for mortality from snake bite in a tertiary care setting.
abstract: OBJECTIVE
  Envenomation with poisonous snakes is associated with considerable morbidity and mortality. The present study was undertaken with the objectives of assessing anti-snake venom (ASV) use, early adverse reactions to ASV, premedication and clinical outcomes in snake bite patients. Association of various risk factors (age, gender, dose of ASV, time gap between snake bite and ASV administration, use of mechanical ventilation and type of snake bite) with mortality was also assessed.
  
  
  METHODS
  This retrospective study was conducted at two Tertiary Care Teaching Hospitals.
  
  
  METHODS
  The medical records of 176 patients of snake bite with documented use of ASV were retrospectively analyzed to retrieve relevant data.
  
  
  METHODS
  Descriptive statistics was used to express results about ASV use, early adverse reactions to ASV, premedication and clinical outcomes. Univariate and multivariate analysis was performed to find out significant risk factors associated with mortality.
  
  
  RESULTS
  The main indication for ASV was vasculotoxic snake bite (75%) followed by neurotoxic snake bite (16%). Mean dose of ASV was 18.63 ± 14.52 vials. Prophylactic premedication with corticosteroids alone or in combination with antihistaminic was used in more than 70% patients. Early adverse reactions to ASV were seen in 4% patients. Neurotoxic snake bite was a significant risk factor associated with mortality in multivariate analysis.
  
  
  CONCLUSIONS
  Neurotoxic snake bite is an independent predictor of mortality in snake bite patients. Currently used polyvalent ASV may be less effective in treating neurotoxic snake bite.
authors.affiliation: Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India.
authors.forename: Shraddha M
authors.initials: SM
authors.lastname: Pore
authors.affiliation: Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India.
authors.forename: Sunita J
authors.initials: SJ
authors.lastname: Ramanand
authors.affiliation: Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India.
authors.forename: Praveenkumar T
authors.initials: PT
authors.lastname: Patil
authors.affiliation: Department of Preventive and Social Medicine, BVDU Medical College, Sangli, Maharashtra, India.
authors.forename: Alka D
authors.initials: AD
authors.lastname: Gore
authors.affiliation: Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India.
authors.forename: Mayur P
authors.initials: MP
authors.lastname: Pawar
authors.affiliation: Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India.
authors.forename: Smita L
authors.initials: SL
authors.lastname: Gaidhankar
authors.affiliation: Department of Pharmacology, Government Medical College, Miraj, Maharashtra, India.
authors.forename: Ravi R
authors.initials: RR
authors.lastname: Ghanghas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000997:Antivenins / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000401:mortality / Q000517:prevention & control; D012189:Retrospective Studies; D012307:Risk Factors; D012909:Snake Bites / Q000188:drug therapy* / Q000401:mortality*; D063128:Tertiary Health Care / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D000997:Antivenins
keywords: Antivenoms; mortality; premedication; snake bite