Evaluation of Snake Bite Poisoned Cases "Clinical and Biochemical Predictors"

Abstract

Background : in Egypt, there are several species of poisonous snakes. The current work aimed to evaluate the clinical and biochemical predictors of snakebite-poisoned patients admitted to Menoufia university poison control center (MPCC). Patients and methods : this work was an observational study done on 67 snakebite cases. Patient's data included sociodemographic data, site of bite, season of bite occurrence, time of presentation to hospital, and clinical manifestations with local and systemic examination. Required laboratory investigations were arterial blood gases (ABGS), complete blood count (CBC), international normalized ratio (INR), prothrombin time (pt), liver enzymes (ALT and AST), serum creatinine and blood electrolytes (sodium and potassium). Cases were classified according to the snakebite weakness and paralysis scoring into symptomatized four groups. The outcome is categorized as cured or dead. Results : the total number of cases was 67 patients manifested with neurotoxicity. Patients were sorted into grade 1 (38 cases), grade 2 (14 cases) grade 3 (8 cases), and grade 4 (7 cases). Most of the cases in whole and in different severity groups were males, in the age group 18-60 years, and from rural areas. As regards the time of presentation, 44.8% of all cases were presented in less than 4 hours. Regarding the place of admission, 77.6% of patients were admitted to the toxicology department. The most common local manifestations were fang marks and pain. Ptosis was the most common neuromuscular manifestation. Most cases were cured (97.0 %). Mortality rate was 3%. Patients with grade 3 and grade 4 snake severity scores were associated with affection of ABGS findings with hypoxia and respiratory acidosis, and with increased white blood cell count, elevated serum creatinine, and liver enzymes (AST, and ALT). Conclusion and recommendations : snakebites are a life-threatening condition. In the present study, neurotoxic snakebites were the most common type of snake in the Menoufia governorate. Patients with respiratory failure and needing mechanical ventilation were associated with increased mortality. Laboratory parameters such as ABGS, WBC, serum creatinine, AST, and alt were important predictors of severity.