A study on the acute kidney injury in snake bite victims in a tertiary care centre

Introduction: Snake bite is a common medical emergency and an occupational hazard, more so in tropical India, where farming is a major source of employment. Viper bites are more common than other poisonous snakebites in humans. The World Health Organization has estimated that there are approximately 1,25,000 deaths among 2,50,000 poisonous snake bites worldwide every year, of which India accounts for 10,000 deaths. Acute kidney Injury (AKI) is an important consequence of a snake bite and its proper supportive management after the anti-venom administration is of utmost importance, for a good patient outcome.

Aims and objectives: 1. To assess the risk factors and the prognostic factors in snake-bite induced Acute Kidney Injury.2. To determine the outcome of snake bite patients with AKI in a tertiary care centre in Karnataka, India.

Methodology: This prospective study was carried out at Vijaynagar Institute of Medical Sciences, Bellary, Karnataka, India. This institute is a referral government hospital in north Karnataka, India.

Study design: This was a prospective and descriptive type of study.

Results: A total of 246 cases of venomous snakebite were included in this study, who were admitted in the hospital from November 2007 to October 2008. Among the AKI and the non-AKI patients, Illiteracy was more among the patients who suffered from AKI (75%). In our study, among all the patients (both AKI and non-AKI patients), viper bite was the commonest and it was seen in 31(91.6%) cases among the AKI patients and in 142 (67.6%) cases among the non-AKI patients. In our study, a majority of the patients who developed AKI had initially visited traditional healers before visiting our hospital, which was found to be statistically significant. In the present study, disseminated intravascular coagulation (DIC) and intravascular haemolysis were found to be predominant among the AKI patients. The "Bite to Needle" time was significantly more in the patients who developed AKI as compared to that in those who developed non-AKI. Out of 36 patients who suffered from AKI, 28 (77.7%) patients survived. Among them, 27(96.7%) patients developed cellulitis, 25(89.5%) had regional lymphadenopathy, 22(81.2%) were bitten at their lower limbs, and 6 (23.8%) patients developed bleeding manifestations.

Conclusion: This study concludes that acute kidney injury occurs in 14.6% of the victims of snake bite. The common manifestations include cellulitis, bleeding manifestations and gangrene at the site of the bite.