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Letters to the Editor

Indian Pediatrics 2006; 43:553-554

Snakebite Envenomation in India: A Rural Medical Emergency

Snakebite is a common medical emergency encountered among Indian population(1). According to World Health Organisation, 15,000 people of 2,00,000 bitten by snakes die every year in India(2). The number may be more owing to the lack of proper documentation and the uncounted deaths that occur before reaching the hospital. Most of the affected, including children are from rural areas. Data on snakebite envenomation among Indian children are limited.

A retrospective study was carried out in the Department of Pediatrics, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), a tertiary care hospital at Pondicherry to study the clinical profile of snake bite envenomation. During a period of 34 months (Nov 2002 to Aug 2005) 50 children (9 months to 12 years of age) were admitted for snake bite envenomation. Their clinical profile is given in Table I.


Clinical Profile of Snake Bites Envenomation in Children
Feature n(%)
Hemotoxic bites 42 (84%)
Neurotoxic bites 8 (16%)
No. of deaths
9 (18%)
(all hemotoxic bites)
Disseminated intra- vascular coagulation 5 (10%)
Acute renal failure 9 (18%)
Local cellulitis 33(66%)
Average ASV required 100 ml
Anaphylaxis to ASV 6(12%)
Ventilatory support required
4 (8%)
(all neurotoxic bites)
Average PICU stay 2 days

Most of the poisonous snakes noted in this area belong to the hemotoxic group. The mortality in hemotoxic group (9/42) is more than the neurotoxic group (0/8). Fifty per cent children with neurotoxicity required mechanical ventilation. The pediatric data presented above is only the tip of the iceberg. Several factors like inappropriate first aid, delay in ASV administration, and anaphylaxis to ASV may affect the outcome. Harmful practices especially tight tourniquet applica-tions and unnecessary surgical procedures add to the morbidity and unscientific methods like ‘black stone’ healing contribute to the delay in seeking appropriate medical care. There is an urgent need to educate the rural population about the hazards and proper first aid for snakebites. Ready availability and appropriate use of antisnake venom, close monitoring of patients, and timely institution of ventilatory support help in reducing the mortality(3). Randomised controlled trials are needed to investigate regarding rationale use of antivenom treatment(4). Considering the magnitude of this rural emergency and the cost involved, a National programme for this issue is needed and research in region specific monovalent antisnake venom production should be encouraged.

B . Adhisivam,
S. Mahadevan,

Department of Pediatrics,
Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER),
Pondicherry 605 006, India.
E-mail: adhisivam1975@yahoo.co.uk 


1. Kulkarni ML, Anees S. Snake venom poisoning: Experience with 633 cases. Indian Pediatr 1994; 31: 1239-1243.

2. Reid HA, Theakston ROG. The management of snake bite. Bull World Health Org 1986; 61: 885-895.

3. Punde DP. Management of snake-bite in rural Maharashtra: a 10-year experience. Natl Med J India 2005; 18: 71-75.

4. Sharma N, Chauhan S, Faruqi S, Bhat P, Varma S. Snake envenomation in a north Indian hospital. Emerg Med J 2005; 22: 118-120.


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