Sage Journals: Discover world-class research

Abstract

Aims and Background

Snakebite envenomation remains a significant public health issue in India, with a continuous need for comprehensive data on its epidemiology, clinical manifestations, and treatment outcomes. This study aims to analyze the demographic, clinical, and epidemiological profiles of snakebite victims and evaluate their clinical outcomes.

Materials and Methods

This retrospective observational study was conducted over 1 year (January–December 2024) at a 2500-bed tertiary care hospital in Mangaluru. Using a chart review method, data were collected from medical records of patients admitted with snakebite history. The study analyzed demographic details, clinical signs and symptoms, treatment protocols, and laboratory findings.

Results

A total of 183 snakebite cases were documented. There was a clear link between the type of treatment provided and patient outcomes, including discharge status, complications, and mortality. Key factors influencing outcomes included co-existing health conditions, delay in hospital presentation, severity of local and systemic envenomation, and the species of snake involved. Patients with delayed access to care often presented with significant laboratory abnormalities, reflecting severe envenomation.

Conclusion

The study underscores the ongoing threat of snakebite in India and the critical need for prompt medical care. Delays in treatment were associated with worse clinical and laboratory outcomes. These findings highlight the importance of rapid response systems, early intervention, and adherence to treatment protocols, and they offer valuable guidance for improving public health strategies and clinical management of snakebite cases.

Keywords

Bite snake clinical outcomes retrospective chart review

Introduction

Snakebite envenomation poses a significant global health burden and was officially recognized as a neglected tropical disease by the World Health Organization (WHO) in 2017.¹ India bears a disproportionate share of this crisis, with an estimated 2 million snakebites annually, resulting in 50,000-60,000 deaths each year.² Beyond mortality, snakebite survivors often endure long-term morbidity, including limb amputations, musculoskeletal deformities, chronic kidney injury, neurological deficits, and post-traumatic stress disorder.³

Recognizing the urgency of this issue, the WHO has set an ambitious target to reduce snakebite mortality to 50% by 2030.⁴ In response to this, India, which is identified as a priority nation, launched the National Action Plan for Prevention and Control of Snakebite Envenoming (NAP-SE), aligning with the WHO’s global road map.⁵ To achieve this goal, we require robust data, including a comprehensive understanding of snakebite epidemiology, clinical manifestations, and treatment outcomes.

Climate change along with the rapid expansion of human habitats is driving significant shifts in temperature, rainfall, and land use, leading to more frequent interactions between humans and snake populations. Consequently, rising temperatures, habitat fragmentation, and urban encroachment are propelling snakes into new territories, thereby escalating the incidence of snakebites and posing a critical public health challenge.⁶ The burden of snakebite diversity is high in India due its vast and varying landscape and vegetation.

India is home to numerous snake species, but four venomous species, known as the “Big Four”—the Indian cobra, the common krait, Russell’s viper, and the saw-scaled viper—are responsible for most medically significant bites. Non-venomous species such as the Indian rat snake, checkered keelback, common wolf snake, and green vine snake are also commonly encountered. There is lack of awareness and misconceptions about snakes among the community, which results in harmless snakes being killed out of fear, while venomous species are mishandled, increasing the risk of envenomation.

Despite the significant burden of snakebites, gaps remain in public awareness, first-aid practices, access to antivenom, and overall patient management. Effective snakebite management depends not only on early clinical recognition, which includes local signs (pain, swelling, ecchymosis, blistering, paresthesia) and systemic symptoms (neurotoxicity, coagulopathy, renal and cardiac effects), but also on rapid diagnosis, appropriate antivenom administration, and supportive care. Laboratory investigations, such as the 20-minute whole blood clotting test (20WBCT), coagulation profiles, and organ function tests, play a crucial role in confirming envenomation.⁷

To bridge these gaps, snakebite profile studies are critical. They provide valuable epidemiological data on who is affected, which snakebites are the most prevalent, and how different envenomations present clinically. Such studies help evaluate treatment practices, first-aid practices, effectiveness of public health policies, patient outcomes, and planning preventive strategies through education and habitat management.

Given these critical gaps, we undertook this 1-year retrospective study with the aim: to analyze the demographic, clinical, and epidemiological profiles of snakebite victims and evaluate their clinical outcomes.

Methods

After receiving approval from the Institutional Ethics Committee, we conducted a retrospective observational study using the chart review methodology. We extracted data from medical records of snakebite patients admitted to a 2500-bed tertiary care hospital between January and December 2024. The facility includes an 80-bed intensive care unit with dialysis capabilities and a blood bank.

Snakebite is a notifiable disease, and all patient information was accessible through the hospitals Electronic Medical Records system. Our study included all patients who presented to the Emergency Department with snakebite history and were managed according to the hospitals standardized protocol.

This protocol involved collecting detailed information about the incident, including the time and location of the bite, snake identification (either by patient description or by comparison with reference images), and documentation of any treatments received before hospital arrival. Each patient underwent a comprehensive clinical assessment, including the measurement of vital signs (heart rate, blood pressure, temperature, oxygen saturation, and respiratory rate) and documentation of preexisting medical conditions.

The envenomation evaluation included an assessment of both local and systemic manifestations. Local signs examined were swelling, edema, pain, bleeding, ulceration, blistering, bruising, and compartment syndrome (identified by pain, paresthesia, pallor, pulselessness, and paralysis). Systemic manifestations were categorized as hemotoxic (malaise, abdominal pain, weakness, drowsiness, hypotension, syncope, shock, cardiac arrhythmias, myocardial damage, and bleeding manifestations); neurological (diplopia, dysarthria, dysphagia, dysphonia, dyspnea, ptosis, and paralysis); and rhabdomyolysis (muscle stiffness, tenderness, pain on passive stretching, trismus, and dark brown urine).

Diagnostic testing included the 20-minute whole blood clotting test (20WBCT), performed by collecting 2 mL of venous blood, transferring it to a glass test tube, and observing for clot formation after 20 minutes. The absence of clotting indicated coagulopathy. For suspected neurotoxic envenomation, we conducted the single-breath-count test (normal: >30 counts), breath-holding time assessment (normal: 40–45 seconds), inter-incisor distance measurement (normal: ≥3 fingers), and the duration of sustained upward gaze.⁸

For suspected hemotoxic envenomation, we performed serial 20WBCT tests every 30 minutes for the first 3 hours, along with comprehensive laboratory investigations: complete blood count, platelet count, coagulation profile, renal function tests, and serum electrolytes. All patients received electrocardiograms, with chest X-rays performed as indicated. Patients without envenomation signs were observed for 6-24 hours, suspected humped nose pit viper cases were observed for 48 hours. Patients declining admission received baseline blood workup and instructions to return immediately if signs or symptoms of envenomation developed.

Patients presenting with envenomation received anti-snake venom (ASV) therapy—10 vials diluted in 500 mL normal saline administered over 1 hour—following premedication with Injection Pheniramine Maleate 22.75 mg (Avil 1 ampoule) and 100 mg hydrocortisone—to prevent hypersensitivity reactions. Patients were closely monitored for infusion-related reactions, including cutaneous rashes, facial swelling, chills, tremors, cough, dizziness, throat tightness, vomiting, tachypnea, hypoxia, sweating, and bronchospasm. If reactions occurred, the infusion was temporarily suspended while symptomatic treatment, including intramuscular injection Adrenaline (0.5 mg), was administered. The infusion resumed cautiously after 10-15 minutes or symptom resolution.

Patients requiring intensive monitoring or mechanical ventilation were transferred to the ICU. All patient details were documented according to the performa in Table 1. Patients who left against medical advice were instructed to monitor for envenomation signs and return promptly if symptoms developed.

Table 1.

Data Collection Performa.

Patient OP/IP number
Gender Male Female
Age in years
Time of bite
Date and month
Site of bite Upper limb (arm, forearm, fingers) Lower limb (thigh, leg, foot, toes) Others (specify)
Activity during bite
Arrival time to the hospital
Tourniquet Present Absent
Local treatment Received Not received
GCS on arrival
Local signs and symptoms
General signs and symptoms
20-minute WBCT Positive Negative
Did the victim or bystander identify the snake?
If yes, specify which one?
ASV Given Not given
Reaction to ASV Present Not present
Duration of stay in the hospital
Lab values: CBC, LFT, coagulation, RFT, and electrolytes values
Course in the hospital: treatment received
Final outcome

Statistical Analysis

The demographic, clinical, and epidemiological profiles of snakebite victims are summarized using descriptive statistics. For categorical variables such as gender, site of bite, occupation, activity during bite, tourniquet use, local treatment, 20-minute WBCT result, snake identification, ASV administration, reaction to ASV, and final outcome, frequencies and percentages are calculated and presented. For continuous variables such as heart rate and BP measurement, the mean and standard deviation are assessed.

Results

The demographic and epidemiological profiles of the included patients are shown in Table 2, the clinical assessment and interventions done are shown in Table 3, the relationship between outcome variables and observed variables is shown in Table 4, and the associations between outcome variables are depicted in Table 5.

Table 2.

Frequency and Percentage of 183 Patients Depicting the Demographic and Epidemiological Characteristics.

Gender	Male	130 (71%)
Gender	Female	53 (29%)
Age	1–10 years	12 (6.6%)
	11–20 years	20 (10.9%)
	21–30 years	32 (17.5%)
	31–40 years	29 (15.8%)
	41–50 years	31 (16.9%)
	51–60 years	35 (19.1%)
	>60 years	24 (13.1%)
Heart rate	83.99 ± 14.94	Mean ± SD
Systolic blood pressure	131.85 ± 18.82	Mean ± SD
Diastolic blood pressure	81.89 ± 10.72	Mean ± SD
Comorbidities	Nil	119 (65%)
	Diabetes mellitus (DM)	28 (15.3%)
	Hypertension	21 (11.5%)
	Ischemic heart disease (IHD)	7 (3.8%)
	Chronic obstructive pulmonary disease	4 (2.2%)
	DM + IHD	4 (2.2%)
Month of bite	January	13 (7.1%)
	February	13 (7.1%)
	March	13 (7.1%)
	April	8 (4.4%)
	May	23 (12.6%)
	June	21 (11.5%)
	July	12 (6.6%)
	August	12 (6.6%)
	September	16 (8.7%)
	October	21 (11.5%)
	November	19 (10.4%)
	December	12 (6.6%)
Time of bite	5 AM to noon	48 (26.2%)
	12:01 PM to 4 PM	26 (14.2%)
	4:01 PM to 7 PM	47 (25.7%)
	7:01 PM to 4:59 AM	62 (33.9%)
Time taken to reach the tertiary hospital from the time of bite	0–4 hours	152 (83.1%)
	4–8 hours	19 (10.4%)
	8–24 hours	5 (2.7%)
	More than 24 hours	7 (3.8%)
Site of bite	Right upper limb	31 (16.9%)
	Left upper limb	28 (15.3%)
	Right lower limb	64 (35%)
	Left lower limb	60 (32.8%)
Activity during bite	Accidental/work related	179 (97.8%)
Activity during bite	Provoked/mishandling	4 (2.2%)
Tourniquet on arrival	Present	128 (69.9%)
Tourniquet on arrival	Absent	55 (30.1%)

Table 3.

Frequency and Percentage of 183 Patients Depicting the Clinical Assessment and Interventions Done.

Treatment received before reaching the tertiary care hospital	10 vials of ASV	13 (7.1%)
	Inappropriate dose of ASV	3 (1.6%)
	Tetanus toxoid	1 (0.5%)
	Antibiotics	1 (0.5%)
	Corticosteroids	2 (1.1%)
	Bite site incised	1 (0.5%)
	Intubation	1 (0.5%)
	No treatment received	161 (88%)
Glasgow coma scale	3	3 (1.6%)
	8	1 (0.5%)
	12	3 (1.6%)
	15	176 (96.3%)
Local signs and symptoms	Present	92 (50.3%)
Local signs and symptoms	Absent	91 (49.7%)
Systemic signs and symptoms	Present	18 (9.8%)
Systemic signs and symptoms	Absent	165 (90.2%)
20-minute whole blood clotting time	Positive	55 (30.1%)
20-minute whole blood clotting time	Negative	128 (69.9%)
Snake identification	Snake not identified	133 (7.1%)
	Cobra	9 (4.9%)
	Krait	9 (4.9%)
	Viper	22 (12%)
	Python	3 (1.6%)
	Rat snake	3 (1.6%)
	Wolf snake	1 (0.5%)
	Trinket	1 (0.5%)
	Hump nose pit viper	2 (1.1%)
ASV administered	Yes	83 (45.4%)
ASV administered	No	100 (54.6%)
Reaction to ASV	Yes	6 (3.3%)
Reaction to ASV	No	177 (96.7%)
Duration of stay in hospital	Less than 1 day	51 (27.9%)
	1–3 days	83 (45.4%)
	4–7 days	34 (18.6%)
	8–14 days	10 (5.5%)
	More than 14 days	5 (2.7%)
Deranged lab values	Normal lab parameters	116 (63.4%)
	Leukocytosis with thrombocytopenia	11 (6%)
	Deranged prothrombin and INR values	23 (12.6%)
	Leukocytosis with deranged prothrombin/INR	27 (14.8%)
	Deranged renal parameters	1 (0.5%)
	Deranged liver parameters	1 (0.5%)
	Deranged renal parameters with deranged prothrombin/INR	4 (2.2%)
Treatment received in the hospital	Observation	96 (52.5%)
	Cellulitis requiring dressing	5 (2.7%)
	Cellulitis requiring debridement	3 (1.6%)
	Transfusion of blood and blood products	6 (3.3%)
	Dialysis	4 (2.2%)
	Supportive ICU care	54 (29.5%)
	Intubation and blood products transfusion	5 (2.7%)
	Cellulitis and blood products	3 (1.6%)
	Dialysis and blood products	2 (1.1%)
	BP-reducing medications	1 (0.5%)
	Denied ASV treatment	3 (1.6%)
	Death within 2 hours of arrival	1 (0.5%)
Final outcome	Discharged with full recovery	132 (72.1%)
	Left the hospital against medical advice	44 (24%)
	Death in the hospital	3 (1.6%)
	Advised follow-up dialysis on discharge	4 (0.5%)

Table 4.

Relationship Between Outcome Variables: Duration of Stay in the Hospital, Deranged Lab Values, Treatment Received, and Final Outcome with Other Measured Variables.

Variable	Duration of Stay in the Hospital		Deranged Lab Values		Treatment Received in the Hospital		Final Outcome
Variable	χ ²	Sig.	χ ²	Sig.	χ ²	Sig.	χ ²	Sig.
Comorbidities	20.02	0.45	32.13	0.36	123.04	0.00	26.93	0.02
Time to reach the tertiary care hospital	37.91	0.00	52.18	0.00	116.95	0.00	48.08	0.00
Activity during bite	15.39	0.05	7.67	0.81	36.70	0.02	15.89	0.01
Tourniquet on arrival	1.39	0.84	7.82	0.25	10.98	0.44	3.13	0.37
Local signs and symptoms	44.98	0.00	55.67	0.00	76.66	0.00	12.87	0.01
Systemic signs and symptoms	29.46	0.00	49.21	0.00	54.03	0.00	23.86	0.00
20-minute whole blood clotting time	32.83	0.00	64.55	0.00	66.56	0.00	14.09	0.00
Snake identified	53.68	0.01	33.54	0.94	114.95	0.02	22.36	0.55
ASV received	82.54	0.00	96.48	0.00	141.99	0.00	37.83	0.00

Note: Sig. = Significance.

Table 5.

Association Between Outcome Variables.

Variable	Final Outcome
Variable	χ ²	Significance
Duration of stay in the hospital	151.54	0.00
Deranged lab values	209.94	0.00
Treatment received in the hospital	265.26	0.00

Discussion

The present study provides insights into the demographic and clinical characteristics of snakebite victims presenting to a tertiary care center. Understanding the specific epidemiological patterns and clinical characteristics of snakebites within particular regions is crucial for developing and implementing targeted public health interventions. This report aims to analyze the findings of a profile study conducted in Mangaluru.

Demographic and Epidemiological Profiles

We noticed that there was predominance of males being bitten by snakes, which is consistent with previous literature, which states that the outdoor activity of males contributes to the increased occurrence of bites among them.^{9, 10} We noticed that people aged 51-60 years and 21-30 years experienced more snakebites, and there are regional variations in the age group among snakebite victims. Meghan noticed more elderly being bitten by snakes in the United States, while Bhavesh noticed more incidents of snakebites in younger populations.^{10, 11} We noticed normal mean baseline vitals of heart rate and blood pressure on arrival. A higher frequency of bites was noted in the months of May, June, and October in our region. Snakes are ectothermic and more active in warmer temperatures, which are typical in May and June, before and during the monsoon. Studies show a positive correlation between higher ambient temperatures and snakebite incidence, especially in spring and summer months.¹² During the monsoon, heavy rains cause flooding and waterlogging of snake habitats, forcing snakes to move and increasing their encounters with humans. Also, the breeding habits of frogs and the rodent population, common prey for snakes, increase during the monsoon and post-monsoon periods. This abundance attracts snakes closer to human dwellings and agricultural fields, where they hunt, leading to more human–snake encounters.¹³ November–January are relatively cooler, and snakes enter a state of brumation, that is, decreased activity to conserve energy, and therefore, the bite incidents are also low.

Most incidents occurred between 7 PM and 5 AM (33.9%), and between 5 AM and noon (26.2%). These findings indicate nocturnal and early morning activity of snakes, periods when visibility is compromised and human activities intersect with snake movement patterns, emphasizing the importance of preventive strategies such as the use of protective footwear and bed nets during sleep.^{10, 14} A majority of patients (83%) reached the tertiary care facility within 4 hours of the bite, suggesting improved awareness or access to medical care. However, a small proportion (6.6%) had delays exceeding 8 hours, underlining the need for continued community education and improved transport infrastructure.¹⁵ The lower limbs were the most common site of bite, which aligns with the existing literature noted by Jarvani and Satyanarayan and highlights the need for protective legwear in at-risk populations.^{10, 16} A majority of the bites were due to accidental bites, and 4 out of the 183 bite incidents were due to snake mishandling and provoked bites; this emphasizes the safe handling of snakes, which includes knowledge, caution, and the use of proper techniques and tools to minimize risk to both the handler and the snake. The use of tourniquets was noted in 70% of cases, reflecting ongoing reliance on traditional first-aid practices, despite their potential for harm. This finding signals a crucial gap in public knowledge and points to the need for targeted health education interventions promoting evidence-based pre-hospital care.^{13, 17}

Clinical Presentation and Early Management

Pre-hospital care was found to be suboptimal in 3 out of 183 patients, with one case involving a harmful procedure such as incising the bite site. The continued use of such detrimental practices highlights a persistent lack of awareness and education within the community.¹⁸ Identifying snake species remains a considerable challenge, with 72.7% of cases involving unidentified snakes. Among the cases where species were identified, vipers accounted for the highest proportion (12.0%), followed by cobras and kraits, each representing 4.9% of cases. A scoping review on identifying snakes where snakebites are common involves a variety of approaches such as capturing or killing the biting snake for examination, descriptions provided by the victim or bystanders, assessment of clinical symptoms, laboratory testing, and photographic documentation of the snake. The ability of victims, witnesses, and healthcare workers to recognize and identify the snake is highly context-dependent, influenced by the circumstances surrounding the bite, the diversity of local snake species, and their familiarity with these snakes. Taking a photograph of the snake may serve as a practical alternative in some cases.¹⁹ Local signs and symptoms were observed in 50.3% of the cases, while systemic manifestations occurred in only 9.8%, indicating that local envenomation was more common. The occurrence of systemic envenomation among snakebite patients varies significantly—ranging from approximately 14% to over 90%—depending on the snake species involved and the geographical region. This underscores the wide variability in envenomation severity and emphasizes the need for context-specific data.²⁰

Treatment Modalities and Course in Hospital

Antivenom was administered to 45.4% of patients based on clinical and laboratory evidence of envenomation, with a low adverse reaction rate (3.3%). The majority of patients (73.2%) required a hospital stay of less than 3 days, suggesting predominantly mild to moderate envenomation severity in our population. However, 15 patients (8.2%) required hospitalization exceeding 8 days, indicating severe envenomation or complications. Laboratory abnormalities were present in 36.6% of the cases, with coagulation disturbances being the most common (29.5% had deranged prothrombin/INR values with or without other abnormalities). This reinforces the predominance of hemotoxic envenomation in our patient population, consistent with the regional prevalence of viper bites. Snakebite envenomation leads to significant derangements in hematological, renal, and inflammatory parameters. These laboratory findings are critical for diagnosing complications, guiding treatment, and predicting patient outcomes.^{3, 10, 13}

The spectrum of interventions ranged from simple observations (52.5%) to intensive supportive care. Notably, 54 patients (29.5%) required ICU support, 11 patients (6.0%) needed blood product transfusions, and 6 patients (3.3%) required dialysis for acute kidney injury. Surgical interventions for local complications were relatively uncommon, with only 8 patients (4.4%) requiring wound dressing or debridement for cellulitis. Research indicates that snakebite management typically involves antivenom as the primary specific therapy, supplemented by supportive measures such as analgesics, ventilatory support, fluid resuscitation, hemodialysis, blood transfusions, and antibiotics when needed.²¹

The overall mortality rate was 1.6% (three patients), which is comparable to figures reported in similar contexts where antivenom and supportive care are readily available.²² A majority of patients (72.1%) experienced full recovery, while four individuals (2.2%) were discharged with a need for ongoing dialysis, reflecting continued renal issues. Notably, a relatively high percentage (24.0%) of patients left the hospital against medical advice, highlighting the need to explore potential socioeconomic factors that may hinder the completion of treatment. Overall, timely access to antivenom and appropriate supportive care plays a vital role in minimizing snakebite-related deaths. Mortality rates in such settings typically remain low, often between 1% and 3%.²²

Association Between Outcomes: Duration of Stay in Hospital, Deranged Lab Values, Treatment Received in the Hospital, Final Outcome, and Other Measured Variables

The present study showed a significant association between the time to reach tertiary care hospital, activity during bite, local and systemic signs of envenomation, 20-minute WBCT, the type of snake, and ASV administration and the length of stay in the hospital. Studies have consistently shown that delays in seeking medical care are associated with longer hospital stays and increased morbidity.²³ The severity of envenoming is a significant determinant of hospital stay duration. Patients with severe systemic manifestations, such as respiratory failure, acute renal failure, or hematologic abnormalities, require longer hospitalization. A study in South India reported that patients with severe envenomation had a mean hospital stay of 8.2 days, compared to 4.8 days for those with mild envenoming, similar to our findings.⁹

We also documented significant derangement in lab parameters with patients who took prolonged time to reach the hospital, local and systemic signs of envenomation, 20-minute WBCT and ASV administration; these findings are consistent with findings of Satyanarayan et al and Jayaram et al.^{16, 23} The study noted a significant association between the treatment received in a hospital and the final outcome (discharged/mortality/morbidity), with variables such as existing comorbidities of patients, time taken to reach the hospital, local and systemic signs of envenomation, type of snake and ASV administration. This implies that these parameters are crucial for predicting outcomes; it is also important to consider that individual patient responses can vary significantly based on factors such as overall health, severity of envenomation, and specific snake species involved.^23-25 This study also revealed a significant association between outcome variables. The length of stay in the hospital, deranged lab values, and treatment received in the hospital had a significant association with the final outcome in the patients; similar finding were noted by Melit et al, Warrell et al, Saravu et al, and Menon et al.^{15, 21, 26, 27}

Limitations of the Study

The retrospective design prevents establishing clear cause–effect relationships. The study being limited to a single center in Mangaluru restricts generalizability to regions with different snake species and healthcare resources. Missing data, especially from patients who left against medical advice, create a potential selection bias. The lack of detailed socioeconomic analysis misses an opportunity to understand factors affecting patient decisions. The treatment protocol variations could introduce confounding variables that might account for outcome differences. These constraints suggest future studies would benefit from prospective designs, multicenter collaboration, standardized treatment protocols, and more comprehensive socioeconomic data collection to strengthen the evidence base for snakebite management.

Conclusion

This study underscores snakebite envenomation as a persistent public health challenge in India, providing critical insights into demographic patterns and clinical factors that significantly influence patient outcomes. The identification of key prognostic indicators—including time to hospital presentation, local and systemic signs of envenomation, comorbidities, and snake species—establishes an evidence base for optimizing treatment protocols and developing targeted interventions for vulnerable populations

Clinical Significance

This study reinforces the urgent need for rapid medical intervention in snakebite cases, as delayed hospital arrival was strongly associated with worse clinical outcomes and abnormal lab findings. It underscores the importance of early recognition and administration of ASV to mitigate morbidity and mortality. The data also reveal that preexisting comorbidities and specific envenomation signs significantly impact recovery, offering a framework for risk stratification in clinical settings. These findings can guide public health policies to enhance awareness, expedite referrals, and optimize treatment protocols for snakebite victims in India.

Footnotes

Authors’ Contribution

Shailaja Sampangiramaiah: Design, definition and intellectual content, literature search, clinical studies, data acquisition, data analysis, statistical analysis, manuscript preparation, editing and review, guarantor.

Nagesh Karpur Ramegowda: Design, definition and intellectual content, manuscript preparation, editing and review, guarantor.

Joanne Juliet Sequeira: Literature search, clinical studies, data acquisition, data analysis, manuscript preparation, editing and review, guarantor.

Ruban Shaun Dsouza: Literature search, clinical studies, manuscript preparation, editing and review, guarantor.

Declaration of Conflict of Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical Approval

Ethical approval was obtained from the Institutional Ethics Committee (FMIEC/CCM/185/2025).

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

Informed Consent

Informed consent was taken from the patients before the conduct of the study.

References

Minghui

, Malecela

, Cooke

, Abela-Ridder

WHO’s snakebite envenoming strategy for prevention and control. Lancet Glob Health . 2019;7:e837-838.

Swain

, Gore

Snakebite envenoming and associated factors in an Indian context. Indian J Community Med . 2021;46:155-156.

Jayawardana

, Arambepola

, Chang

, Gnanathasan

Long-term health complications following snake envenoming. J Multidiscip Healthc . 2018;11:279-285

World Health Organization. WHO launches global strategy for prevention and control of snakebite envenoming. Accessed February 4, 2026. https://www.who.int/news/item/23-05-2019-who-launches-global-strategy-for-prevention-and-control-of-snanebite-envenoming

Munshi

, Gajbhiye

RK.

National Action Plan for the prevention and control of snakebite envenoming in India: strategies and challenges. Trans R Soc Trop Med Hyg . 2025. doi:10.1093/trstmh/trae068

Bhaumik

, Beri

, Jagnoor

The impact of climate change on the burden of snakebite: Evidence synthesis and implications for primary healthcare. J Family Med Prim Care . 2022;11:6147-6158. doi:10.4103/jfmpc.jfmpc_677_22

Warrell

, Williams

Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet . 2023;401:1382-1398. doi:10.1016/S0140-6736(23)00002-8

Bickler

, Abouyannis

, Bhalla

, Lewin

MR.

Neuromuscular weakness and paralysis produced by snakebite envenoming: mechanisms and proposed standards for clinical assessment. Toxins (Basel) . 2023;15:49. doi:10.3390/toxins15010049

Harsoor

, Honnungar

, Lakhkar

, Chikkegowda

, Veerappa

KB.

A study on the clinico-epidemiological profile and the outcome of snake bite victims in a tertiary care centre in southern India. J Clin Diagn Res . 2013;7:122-126. doi:10.7860/JCDR/2012/4842.2685

10.

Jarwani

, Jadav

, Madaiya

Demographic, epidemiologic and clinical profile of snake bite cases, presented to Emergency Medicine Department, Ahmedabad, Gujarat. J Emerg Trauma Shock . 2013;6:199-202. doi:10.4103/0974-2700.115343

11.

Spyres

, Ruha

, Kleinschmidt

, Vohra

, Smith

, Padilla-Jones

Epidemiology and clinical outcomes of snakebite in the elderly: a ToxIC database study. Clin Toxicol (Phila) . 2018;56:108-112. doi:10.1080/15563650.2017.1342829

12.

Landry

, D’Souza

, Moss

, . The association between ambient temperature and snakebite in Georgia, USA: a case-crossover study. Geohealth . 2023;7:e2022GH000781. doi:10.1029/2022GH000781

13.

Kumar

, Kumar

, Raj

, Sheikh

NA.

Understanding pediatric snakebites: clinical and epidemiological insights from a healthcare center in Bihar, India. J Family Med Prim Care . 2024;13:3011-3016. doi:10.4103/jfmpc.jfmpc_1817_23

14.

Sharma

, Dogra

, Sharma

, Chauhan

Mass awareness regarding snake bite induced early morning neuroparalysis can prevent many deaths in North India. Int J Crit Illn Inj Sci . 2016;6:115-118. doi:10.4103/2229-5151.190652

15.

Melit

, Abraham

, Radhakrishnan

, . Retrospective review of case records of snakebite presenting to a single tertiary care centre over a 5-year period. Natl Med J India . 2021;34:326-332. doi:10.25259/NMJI_97_20

16.

Satyanarayan

, Panda

, Sunder

, Kumari

Clinical and epidemiological profile of snakebite cases: a study from an industrial teaching hospital at Jamshedpur, Jharkhand, India. J Family Med Prim Care . 2022;11:7652-7656. doi:10.4103/jfmpc.jfmpc_890_22

17.

Parker-Cote

, Meggs

WJ.

First aid and pre-hospital management of venomous snakebites. Trop Med Infect Dis . 2018;3:45. doi:10.3390/tropicalmed3020045

18.

Maduwage

, Kodagoda Gamage

, Gutiérrez

JM.

First aid and pre-hospital practices in snakebite victims: the persistent use of harmful interventions. Toxicon . 2024;238:107582. doi:10.1016/j.toxicon.2023.107582

19.

Bolon

, Durso

, Botero Mesa

, . Identifying the snake: first scoping review on practices of communities and healthcare providers confronted with snakebite across the world. PLoS One . 2020;15:e0229989. doi:10.1371/journal.pone.0229989

20.

Afroz

, Siddiquea

, Chowdhury

, Jackson

, Watt

AD.

Snakebite envenoming: a systematic review and meta-analysis of global morbidity and mortality. PLoS Negl Trop Dis . 2024;18:e0012080. doi:10.1371/journal.pntd.0012080

21.

Warrell

, Williams

DJ.

Clinical aspects of snakebite envenoming and its treatment in low-resource settings. Lancet . 2023;401:1382-1398. doi:10.1016/S0140-6736(23)00002-8

22.

Sharma

, Chauhan

, Faruqi

, Bhat

, Varma

Snake envenomation in a North Indian hospital. Emerg Med J . 2005;22:118-120. doi:10.1136/emj.2003.008458

23.

Jayaraman

, Dhanasinghu

, Kuppusamy

, Gaur

, Sakthivadivel

Bite-to-needle time: an extrapolative indicator of repercussion in patients with snakebite. Indian J Crit Care Med . 2022;26:1175-1178. doi:10.5005/jp-journals-10071-24344

24.

Senthilkumaran

, Khamis

, Manikam

, Thirumalaikol_undusubramanian

Snakebite and severe hypertension: looking for the Holy Grail. Indian J Crit Care Med . 2014;18:186. doi:10.4103/0972-5229.128715

25.

Mahmood

, Naqvi

, Talib

, . Clinical course and outcome of snake envenomation at a hospital in Karachi. Singapore Med J . 2010;51:300-305.

26.

Saravu

, Somavarapu

, Shastry

, Kumar

Clinical profile, species-specific severity grading, and outcome determinants of snake envenomation: an Indian tertiary care hospital-based prospective study. Indian J Crit Care Med . 2012;16:187-192. doi:10.4103/0972-5229.106499

27.

Menon

, Joseph

, Jose

, Dhananjaya

, Ov

Clinical profile and laboratory parameters in 1051 victims of snakebite from a single centre in Kerala, South India. J Assoc Physicians India . 2016;64:22-29.

Clinical Features and Outcomes in Snakebite Patients: A One-year Retrospective Study

Abstract

Aims and Background

Materials and Methods

Results

Conclusion

Keywords

Introduction

Methods

Data Collection Performa.

Statistical Analysis

Results

Frequency and Percentage of 183 Patients Depicting the Demographic and Epidemiological Characteristics.

Frequency and Percentage of 183 Patients Depicting the Clinical Assessment and Interventions Done.

Relationship Between Outcome Variables: Duration of Stay in the Hospital, Deranged Lab Values, Treatment Received, and Final Outcome with Other Measured Variables.

Association Between Outcome Variables.

Discussion

Demographic and Epidemiological Profiles

Clinical Presentation and Early Management

Treatment Modalities and Course in Hospital

Association Between Outcomes: Duration of Stay in Hospital, Deranged Lab Values, Treatment Received in the Hospital, Final Outcome, and Other Measured Variables

Limitations of the Study

Conclusion

Clinical Significance

Footnotes

Authors’ Contribution

Declaration of Conflict of Interests

Ethical Approval

Funding

Informed Consent

References