A comparative study in the outcome between the two fixed doses of polyvalent anti snake venom, 10 vials versus 20 vials, with mechanical ventilation in children with severe neurotoxic snake envenomation
DOI:
https://doi.org/10.18203/2349-3291.ijcp20202612Keywords:
Anti-snake venom, Mechanical ventilation, Neuroparalysis, Snake biteAbstract
Background: Every year about 50,000, people die of snake bites in India. Anti-snake venom and mechanical ventilation is mainstay of treatment in cases with severe neurotoxic envenomation. ASV is costly and scarce resource. There is lack of universal consensus towards the optimal dose of ASV in management protocol for children with severe neurotoxic snake envenomation. Objective was to compare the difference in outcome between two fixed doses of ASV, 10vials versus 20 vials, in children with severe neurotoxic snake envenomation
Methods: This comparative observational study was carried out for a period of 3 years in Department of Pediatrics of SVS Medical College, Mahabubnagar, Telangana, India. Children with history of snake bite and clinical evidence of neuroparalysis were included. In addition to the mechanical ventilation and other supportive measures, every alternate patient was administered with 10vials (low dose) and 20 vials (high dose) of ASV over 1 hour. Outcome was compared between the two groups.
Results: Of the 62 patients, 32 were in each group. The median time to extubation was 41 hours and 39.5 hours and mean duration of the hospital stay was 4.6 days and 4.5 days among the low dose and high dose groups, respectively. There were three deaths, one from low dose group and two from high dose group.
Conclusions: There was no significant difference in outcome between the 10 vials vs 20 vials of ASV in addition to mechanical ventilation in treatment of children with severe neurotoxic snake envenomation. So, 10 vials of ASV can be utilized to reduce the cost of treatment.
References
Warrell DA. Epidemiology of snake-bite in South-East Asia Region. In: Warrell DA (editor). Guidelines for the management of snakebite. New Delhi: WHO regional office for Southeast Asia; 2010:35-45.
Ghosh S, Mukhopadhyay P, Chatterjee T. Management of Snake Bite in India. J Assoc Physicians India. August 2016;64:11-4.
Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Health Organ.1998; 76(5):515-24.
Kshisagar VY, Ahmed M, Colaco SM. Clinical profile of snake bite in children in rural India. Iran J Pediatr. 2013;23(6):632-6.
Warrell DA. WHO/SEARO Guidelines for the Clinical Management of Snakebite in the Southeast Asian Region. SE Asian J Trop Med Pub Health. 1999;30:1-85.
Bawaskar HS, Bawaskar PH. Management of Snake bite and Scorpion Sting. Quarterly Medical Review. 2009;60(4):4-20.
Paul V, Pratibha S, Prahlad KA, Earali J, Francis S, Lewis F. High-Dose Anti-Snake Venom Versus Low-Dose Anti-Snake Venom in The Treatment of Poisonous Snake Bites- A Critical Study. J Assoc Physicians India. 2004;52:14-7.
Agarwal R, Aggarwal AN, Gupta D, Behera D, Jindal SK. Low dose of snake antivenom is as effective as high dose in patients with severe neurotoxic snake envenoming. Emerg Med J. 2005;22:397-9.
Tariang DD, Philip PJ, Alexander G, Macaden S, Jeyaseelan L, Peter JV, et al. Randomized controlled trial on the effective dose of anti-snake venom in cases of snake bite with systemic envenomation. J Assoc Physicians India. 1999;47:369-71.
Vijeth SR, Dutta TK, Shahapurkar J, Sahai A. Dose and frequency of anti-snake venom injection in treatment of Echis carinatus (saw-scaled viper) bite. J Assoc Physicians India. 2000;48:187-91.
Pandey PC, Bajaj S, Srivastava A. A Clinico-Epidemiological Profile of Neuroparalytic Snake Bite: Using Low Dose ASV in a Tertiary Care Centre from North India. J Assoc Physic India. August 2016;64:16-20.
Gadwalkar SR, Kumar NS, Kushal DP, Shyamala G, Mohammad MZ, Vishwanatha H. Judicious use of antisnake venom in the present period of scarcity. Indian J Crit Care Med. 2014;18:722-7.
Daswani BR, Chandanwale AS, Kadam DB, Ghongane BB, Ghorpade VS, Manu HC. Comparison of Different Dosing Protocols of Anti-Snake Venom (ASV) in Snake Bite Cases. J Clini Diagn Res. 2017;11(9):FC17-FC21.
Das RR, Sankar J, Dev N. High-dose versus low-dose antivenom in the treatment of poisonous snake bites: A systematic review. Indian J Crit Care Med. 2015;19(6):340-9.
