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Rational Use of Anti-Snake Venom: Trial of Various Use Regimes in Hemtoxic Snake Envenomation

Nagabhushana Seetharama, Associate Professor, Dept of Medicine, Shimoga Institute of Medical Sciences, Shimoga, Karnataka 577201, India , Aravinda C.L.1 , Nagabhushana S.1 , Ranganatha M.1 , Virupakshappa V.2

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Indian Journal of Emergency Medicine 3(2):p 190-196, Jul-Dec 2017. | DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3217.3

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Abstract

Background: India is estimated to have the highest snakebite mortality in the world. The hitch with determining the optimum ASV dose is that the quantity of venom injected at a bite is very variable. There are very few studies to determine the effective dose of ASV. But recent studies have found that low dose ASV is as good as or even better (lesser complications) than high dose ASV. Despite evidence for smaller doses from evidencebased medicine, most centers are still using large doses. The is a need for investigating in this area to know the effective dose of ASV in management of snake bite patients resulted in taking up of present study. Material and Methods: this study carried out in Medicine department, SIMS, Shimoga for 6 months from January 2017 to June 2017. 100 snakebite patients with haemostatic abnormality admitted to Mc Gann Hospital. A detailed history was taken in all the patients and a through physical examination was done. CBC, RFT, LFT, BT,CT, PT, INR, ECG, is done. The two study groups are 50 consecutive patients formed Group I (Conventional high dose regime (100ml) group). 50 consecutive patients formed Group II (Low dose regimen (30ml) group). Results: The mean age was 37.67 (± 4.56) years. With male to female ratio being 1.3:1. The mean Snakebite to ASV given time was 14.5hours. Average CT (at presentation), Group 122.6 ±7.59 mins. Group 229.47 ±5.59 mins. ASV dose required, Group 1325 ±183 ml. Group 2175.75 ±±87.4 ml. Time lapse for CT normalization, Group 124.97 ±5.58 hrs. Group 214.93 ±4.49 hrs. About 2025% of patients developed acute renal failure [11 (22%) and 5 (10%) patients in groups I and II respectively]. Number of patients died in Group 15 (10%). Group 24 (8%). Conclusion: The observation that very low dose of ASV is adequate to save lives of victims of poisonous snake bites with early hospitalization and good supportive management. This will definitely decreases economic burden on the society.

Keywords: Venom; Snakebite. 

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DOI: http://dx.doi.org/10.21088/ijem.2395.311X.3217.3

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