1Assistant Professor, Department of General Medicine, Sree Mookambika Institute of Medical Sciences, Kulasekharam, District Kanyakumari, Tamil Nadu, India
2Professor, Department of General Medicine, Bangalore Medical College, Bengaluru, Karnataka, India
3Professor of Community Medicine, Sree Mookambika Institute of Medical Sciences, Kulasekharam, District Kanyakumari, Tamil Nadu, India
The complications related to kidneys are observed in majority of patients with snake bite admitted to a hospital and is an important cause morbidity and mortality. The onset of renal failure in these patients is signaled by the development of oliguria or anuria. Early treatment improves survival in snake bite victims.
To study the renal involvement in patients with snake bite with reference to clinical features and the time of onset of acute renal failure. To study the, course, need for renal replacement therapy including dialysis.
One hundred snakebite patients admitted to Victoria Hospital, Bowring and Lady Curzon Hospitals attached to Bangalore Medical College and Research institute, Bangalore from Oct 2013 – Sept 2014 were studied prospectively using systemic random sampling and particularly looked for development of acute renal failure. Patient or attainders have not seen the snake were excluded. Patients were followed up till discharge or death. Clinical data was tabulated. Statistical analysis was done.
Common signs and symptoms were fang mark (94.7%), swelling (97%), tenderness (89%), blisters (73.6%), bleeding manifestations (73.6%), pallor (71%), oliguria (47%), anuria (10.5%) and haematuria (21%). Hypotension was present in 47% which may be cause of ARF. All the ARF patients showed coagulation abnormalities in the form of prolonged BT, CT, PT and aPTT. Thrombocytopenia was seen in 89%. Albuminuria was present in 46% of patients. All the ARF patients were given ASV for 3 to 5days. Mean ASV vials used in present study is 34.1±10. Platelet transfusion was done in 23.6% and haemodialysis in 28.9% of patients. Two patients became dialysis dependent.
Thrombocytopenia was significantly related to clinical bleeding ARF is usually associated with oliguria and is generally occurs within 48 hours. Bite to ASV therapy time, bite to renal insufficiency time and coagulation abnormalities were the major prognostic factors predicting the final outcomes. Dose of ASV therapy required is more in patients with ARF. Albuminuria is found in all patients who had coagulation abnormalities and ARF.
ARF, Oliguria, Bleeding manifestations, Viper bite
