Management of Snakebite and Research Management of Snakebite ...

The clinical progress and response to treatment in patients with systemic bleeding
and heavy proteinuria (+ 3 and above) in the two groups are shown in Table 4. In these
patients, the venom antigen clearance time was significantly shorter when a bolus dose of
80 ml was given (Table 4). But development of acute renal failure and mortality rates were
similar among these two treatment groups.
Table 4. Response to treatment in patients with
systemic bleeding and/or proteinuria admission.
40+40 ml 80 ml
ASV ASV
Number of patients 8 13
No. of patients developing
acute renal Failure
6 9
Peritioneal dialysis
(no. of cases)
4 4
Deaths (no. of cases) 2 2
Venom antigen clearance 1.7 ± 1.0 1.1± 0.8
time (hours) mean SEM
Clot restoration time
(hours) mean SEM
P< 0.05 (student ‘t’ test).
10.77 7.0 2.5
Detailed analysis of regimen one (n = 23) 11/23 patients (48%) in this group received
only 40 ml of ASV. None of these patients developed any major complications and none
died. 12 patients had to be given additional 40 ml of ASV as their blood failed to reclot six
hours after the initial dose. Close monitoring of these patients in regimen one brought out
an interesting fact. Among patients requiring a second dose of ASV, eight patients (75%)
had heavy proteinuria (+3 and above) and four patients (33%) had spontaneous systemic
bleeding from gastrointestinal tract. This can be compared with one patient (9%) and none
respectively in patients requiring no additional ASV (Tables 5 and 6).
Table 5. Characteristics of patients in regimen
one on admission (comparing patients receiving
40 ml and 40 + 40 ml ASV)
40 ml ASV 40 + 40 ml ASV
Number of patients 11 12
Average age (years) 35 37
Average weight (kg) 51 49
Venom antigen level
(ng/ ml) mean (range)
P< 0.05 (student ‘t’ test).
71
(20-110)
Clinical Management of Russell’s Viper Bites
73
(50-100)
49