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Clinical Profile and Outcome of Children with Snake Envenomation

Rehna Nabeel , Rehna Nabeel , Jhuma Sankar , Leena Priyambada , S. Mahadevan

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Indian Journal of Trauma and Emergency Pediatrics 3(4):p 141-148, October - December 2011. | DOI:

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Abstract

Background: Few studies have evaluated the demographic characteristics, clinical profile and outcome of children with snake envenomation prospectively.Objectives: To evaluate the clinical profile and outcomes of critically ill children with snake envenomation. Methods: This prospective observational study was conducted over a 2 year period from November 2007 to January 2010 in a Pediatric intensive care unit of a tertiary care teaching hospital. Children less than or equal to 12 years of age admitted to our hospital with a definitive history of snake bite were enrolled in the study. Children were treated as per the World Health Organization guidelines on the management of snake bite in children (2005).Results: Out of 67 children studied, 70% (n=47) were males. The presenting features were hemotoxic in 42 (62.7%), neurotoxic in 12 (18%), and only local symptoms in 13 (19.4%) children; bleeding from the site of bite and mucosa was the commonest manifestation. Use of pre-hospital first aid measures such as tourniquet and/or native treatment was found in 25% and 12% of the children respectively. While all children with hemotoxic and neurotoxic features received anti-snake venom, only nine with exclusive local symptoms required it. Ventilation, inotropes, blood products and dialysis were required in 14 (21%), 7 (10%), 11 (16%) and 11 (16%) patients respectively. Of the 67 children, 10(15%) died and 3 (4.5%) had major disability in the form of necrosis and/or skin graft. The commonest causes of death were acute kidney injury and disseminated intravascular coagulation (4 and 3 respectively). Conclusion: Majority of children had features of hematotoxic envenomation. One fifth of the study population had poor outcomes in the form of death and/or major disability.

Key words: Snake envenomation; Snake antivenom; Hematotoxic; Neurotoxic; Snake bite; Whole blood clotting time. 

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