A Study of acute renal failure due to snake bite envenomation

Karthikeyan, R (2006) A Study of acute renal failure due to snake bite envenomation. Masters thesis, Government Mohan Kumaramangalam Medical College, Salem..

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Abstract

INTRODUCTION : Snakes are a fascinating part of nature. Their colour, movement, and secretive habits make them more mysterious. There are about 2700 species of snakes recognized world over of which about 450 species are venomous. Venomous snakes are broadly classified into 4 families : Elapidae, Viperidae, Hydrophilidae, Colubridae. Snakes are classified on morphological grounds from the arrangement of their scales (Lepidosis), dentition, Osteology, Myology, Sensory Organs and Hemipenis and more recently by immunological studies of their venoms and serum proteins. All medically important species of snakes have one or more pairs of enlarged teeth, the ‘ fangs ’ in the upper jaw by which venom is introduced through the skin of human victim. ARF has been mostly reported following bites by snakes of first three of these families, with the majority following viper bites. Snakes whose bites are known to cause renal failure include the sea-snake, Russell’s viper, sawscaled viper, puff adder, rattlesnake, tiger snake, green pit viper, Bothrops jararaca boomslang, gwardar, dugite, and Cryptophis nigrescens. Information on the precise incidence of snake-bite-induced ARF in different geographical regions is lacking. The incidence following Saw scaled viper or Russells’s viper bites in India varies from 13 to 32 percent. The reported incidence from other countries varies between 1 and 27 percent. AIM OF STUDY : 1. Clinical presentation of patients with snake bite induced renal failure. 2. Coagulation abnormalities. 3. Outcome in renal failure due to snake bite. MATERIALS AND METHODS : Patients admitted in Government Mohan Kumaramangalam Medical College, with snake bite induced renal failure and coogulation abnormalities were examined from 10/2004 - 3/2006 - 50 Patients. History was elicited about type of snake, site of bite, time of bite, the native treatment taken, symptoms like oliguria, bleeding tendencies and cellulitis. CLINICAL EXAMINATION : LOCAL EXAMINATION: Site of snake bite is examined for presence of cellulitis, fang marks, bleeding from site of bite, local necrosis, gangrene. GENERAL EXAMINATION: Vital signs like pulse, blood pressure, respiratory rate, sub conjunctival hemorrhage, echymosis, bleeding from bite site, periorbital edema, ptosis, extra ocular movement, cardiovascular system, respiratory system, abdomen, central nervous system examined. CONCLUSION : 1. Seasonal variation was present in snake bite. Incidence and mortality more during January, February, March, April. 2. Males were commonly affected, lower limb being commonest site of snake bite. 3. Of the identified snakes viper bite was the commonest cause of acute renal failure following snake bite. 4. ARF due to snake bite may be both Oliguric and Non – Oliguric of which Oliguric accounts for 90% and Non – Oliguric accounts for 10%. 5. Renal lesion due to snake bite may be of two types – of which Acute tubular necrosis accounts for 70 to 80%, acute cortical necrosis accounts for 20 to 30%. 6. Oliguria which lasts for 4 to 15 days suggests the possibility of acute cortical necrosis which carries worst prognosis. 7. Hypotension, Sub conjunctival hemorrhage, disorientation, Seizures, Hemiplegia, anuria, during presentation were associated with increased mortality. 8. Mortality was less in patients who came with in 6 hours. Mortality was more in patients who came after 6 hours - 4 days of snake bite 9. Majority of patients had hypoalbuminemia and this was correlated with increased morbidity and mortality. 10. Mortality rate was 10%. Early adequate dosage of ASV was associated with better prognosis. Early detection of renal failure and institution of dialysis was associated with better outcome. 11. Commonest cause of mortality was coagulation abnormalities. SUMMARY : Snake bite is an occupational hazard in this part of country. It account for nearly 10% of Hospital admissions in this place and associated with increased mortality. For this purpose the study has been carried in this place. From this study we have come to inference that early treatment with anti snake venom, adequate hydration and prevention of hypotension causes reduce mortality due to ARF from snake bite envenomation. Early adequate dosage of ASV was associated with better prognosis. Early detection of renal failure and institution of dialysis was associated with better outcome.

Item Type: Thesis (Masters)
Uncontrolled Keywords: acute renal failure ; snake bite envenomation.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 16 Feb 2018 14:55
Last Modified: 16 Feb 2018 14:55
URI: http://repository-tnmgrmu.ac.in/id/eprint/5762

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