Management protocol of venomous snakebite in India: a consensus statement

Abstract

Venomous snakebite is a significant cause of mortality and morbidity in South East Asia. The WHO, in 2009 declared venomous snakebite as one of the “neglected diseases of the tropics”. It is estimated that there are over 300 000 snakebites in India alone leading to between 45 000 and 50 000 deaths annually. The majority of venomous bites could be attributed to the big four – Daboia russellii (Russell’s viper), Bungarus caerulus (common krait), Naja naja (Indian cobra) and the Echis carinatus (saw scaled viper). Hemostatic abnormalities are prima facie evidence of hemotoxic snakebite. This could range from a mild cutaneous bleed to catastrophic intra-cerebral bleeds. Hemotoxic snakebite could also lead to Acute Kidney Injury (AKI) and Disseminated Intravascular Coagulation (DIC). A descending paralysis starting as a ptosis, which could progress on to life threatening respiratory paralysis is what is seen in neurotoxic snakebites. Anti-snake venom is started at 10 vials (100 ml) and most bites require up to 20 vials.

Keywords:

• Venomous snake bite
• anti-snake venom (ASV)
• whole blood clotting test (WBCT)
• bleeding manifestations
• descending paralysis
• ptosis

Acknowledgements

The authors acknowledge Dr. B L Dhanajaya for helping in formatting/preparing the article.

Declaration of interest

The authors declare no conflicts of interest.