A Study on the Acute Kidney Injury in Snake Bite Victims in a Tertiary Care Centre
Snake bites are a common environmental hazard, and the World Health Organization estimates that snake bites are responsible for as many as 100,000 deaths per year. The Russell’s viper is one of the most dangerous snakes in Asia and is a common occupational hazard among farming communities in India. Clinical manifestations after Russell’s viper envenomation include pain, diffuse swelling, coagulopathy, and acute kidney injury (AKI). The goal of this study was to assess the risk factors and outcomes for AKI due to snake bite envenomation in India.
This prospective study was performed at the Vijaynagar Institute of Medical Sciences in Bellary, Karnataka, India, and included patients with clear evidence of snake bite envenomation who had new onset of AKI. In all, 246 patients were enrolled during 2007–2008 and AKI developed in 14.6%, with the most common demographic being 20- to 40-year-old illiterate males. The patients in whom AKI developed after a snake bite had the following characteristics: they were more likely to present with severe cellulitis, and were more likely to have bleeding coagulopathies, and they had longer times to definitive medical care. Additionally, patients in whom AKI developed had a longer hospital course, required more antivenom vials, and were more likely to have sepsis. Overall, the mortality rate for patients with AKI was 22.3%.
The investigators concluded that the development of AKI after a viper snake bite in India is a significant predictor of poor outcome. This study identified an educational opportunity to emphasize the importance of seeking definitive medical soon after a snake bite. Limitations of the study include a small sample size and applicability to other populations.
(J Clin Diag Res. 2013:7;853-856). L Harshavardhan, AJ Lokesh, HL Tejeshwari, BR Halesha, SM Siddharama.
Prepared by Andrew Nyberg, MD, University of Utah Wilderness Medicine Fellow, Salt Lake City, UT, USA.