title: Mass awareness regarding snake bite induced early morning neuroparalysis can prevent many deaths in North India.
abstract: BACKGROUND
  In North India snake bite deaths are predominantly seen with neurotoxic envenomations (NEs) whereas in South India the hemotoxic envenomation (HE) is more common. Krait is responsible for most deaths in North India. It bites people sleeping on the floors, mostly at night. We describe the profile of venomous snake bites over 1 year in 2013.
  
  
  METHODS
  The study was conducted in a rural tertiary care hospital in North India. Demographics, circumstances of bite, envenomation, first aid, delay, consultation, treatment, anti-venom, and outcomes were recorded for all victims of snake bite. We included all consecutive adult (>18 years) venomous snake bite victims admitted from January to December 2013.
  
  
  RESULTS
  A total of 91 patients with venomous snake bites were included in the study. Pure NEs were 41 (45.1%), pure HE in 31 (34.1%), 7 (7.7%) had mixed NE + HE, and 12 (13.2%) had only local swelling. Forty patients (44%) were bitten during sleep presenting as NE (92.5%), NE + HE (5%), and HE (2.5%). Findings in the 51 patients (56%) bitten during activity were HE (58.8%), local swelling (23.5%), NE + HE (9.8%), and NE (7.8%) (P< 0.0001). First aid was sought by 24 NE patients out of which 23 (96%) went to alternate practitioners or religious healers.
  
  
  CONCLUSIONS
  Almost all (97.5%) bites during sleep resulted in NE in our study. About 96% of NE sought first aid from alternate practitioners or religious healers in hope of some magical treatment. Thus, a deadly combination of krait bite during sleep and wrong health seeking behavior is responsible for high mortality krait bites in this region. Mass public awareness regarding krait bites can prevent mortality in many such cases.
authors.affiliation: Department of Medicine, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India.
authors.forename: Rupinder
authors.initials: R
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India.
authors.forename: Varundeep
authors.initials: V
authors.lastname: Dogra
authors.affiliation: Department of Medicine, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India.
authors.forename: Gurudutt
authors.initials: G
authors.lastname: Sharma
authors.affiliation: Department of Medicine, Dr. RPGMC Tanda, Kangra, Himachal Pradesh, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Chauhan
keywords: Anti-snake venom; cobra; krait; religious healers; viper