Profile of SnakeBite Patients in Intensive Care Unit: A Clinicoepidemiological Study from North India

Abstract

ABSTRACT Background: Snakebite is a common public health emergency which requires immediate medical attention and intensive care. Globally, more than 11,000 deaths occur every year due to snakebite. We carried out this study to evaluate the epidemiology, clinical profile, and outcomes for patients with snakebite in the intensive care unit (ICU) of our hospital. Materials and Methods: It was a record-based retrospective, descriptive study carried out over a period of 3 years in which the clinicoepidemiological profile of all snakebite patients admitted in the ICU of our hospital was analyzed. Results: Eighty-six patients of snakebite were admitted in our ICU from April 2017 to April 2020. The mean age of the patients in our study group was 32.14 years (range: 18–64 years with male predominance (male: female - 2.44:1). The most common occupational groups were agriculture workers and laborers (77.9%, n = 67). Majority of the snakebites occurred during the night and early morning time (87.2%, n = 75) and were unprovoked. Lower limbs were the most common site of snakebite (63.95%, n = 55), followed by upper limbs (23.25%, n = 20), trunk (11.62%, n = 9), and neck (2.32%, n = 2). Out of 86 patients admitted in ICU, 84 (97%) were intubated. Neuroparalytic symptoms were predominant in most of the patients (95.35%, n = 82), whereas four patients presented with hemotoxic envenomation. Ptosis with double vision and respiratory distress were the most common clinical features of snake envenomation (100% and 95.34%). Coagulopathy in terms of prolonged bleeding time was found in 40.69% cases (n = 35) only. Mechanical ventilation was the most common intervention (97.67%, n = 84) done in the ICU. Four patients developed acute renal failure and were put on hemodialysis. Mortality was seen in two patients (2.32%) due to disseminated intravascular coagulation and intracranial hemorrhage. Conclusions: Neuroparalytic envenomation predominated in our study. Early medical management in the ICU can significantly reduce the mortality.