Clinical and demographic profiling of snakebite envenomation in a tertiary care centre in northern India.

Background: Snake bites are a major cause of emergency visits in tropical countries like India, with actual mortality and morbidity likely higher due to underreporting. The aim of the study was to analyze the clinical and demographic profiles of snake bites at the Department of Emergency Medicine, AIIMS Rishikesh, over two years (July 2021 to July 2023).

Methods: Patients aged over 18 with witnessed or suspected snake bites were included. Data on demographics, clinical history, laboratory parameters, treatment, and outcomes were collected.

Results: Most patients were male (68.3%) and aged 31-50 years (35.6%). Farmers made up 57.4% of the cohort. Bites occurred mostly in the evening (46.5%) and during the monsoon (71.3%). Symptoms varied: 48.5% were asymptomatic, 31.7% had hemotoxic symptoms, and 15.8% experienced neurotoxic symptoms, including ptosis. Hemotoxic bites frequently involved bleeding at the bite site (93.8%) and gum bleeding (46.9%). Local complications were noted in 7.9% of cases. Neuroparalytic bites required ventilatory support in 62.5%. Blood products were administered to 31% of patients with hemotoxic bites, hemodialysis to 19%, and plasmapheresis and hyperbaric oxygen therapy to 6.3%. Out of the 69 symptomatic patients (68.3%) who received anti-snake venom (ASV), 28 (40.6%) patients developed adverse reactions.

Conclusion: This study provides a detailed analysis of suspected snakebites in Uttarakhand and surrounding areas, highlighting the importance of early recognition, prompt treatment, and timely referral to prevent fatalities. The administration of anti-snake venom (ASV) is identified as the most critical intervention, though lack of awareness in rural areas complicates management. The study calls for targeted public health campaigns to educate communities about early snakebite recognition and the role of ASV. It also stresses the need for region-specific protocols and improved healthcare access, emphasizing the importance of referral systems for advanced interventions like hemodialysis and intubation. Overall, the study advocates for enhanced public awareness and healthcare infrastructure to reduce snakebite incidence and mortality in rural populations.