Introduction: Snake bite is considered to be one of the common, neglected and potential life-threatening public health issues in tropical and sub-tropical countries. According to World Health Organization (WHO), 4.5- 5.4 million people get bitten by snakes annually. Acute kidney injury is one of the major health issues due to snake envenomation and can be managed with appropriate dose of Anti-snake venom and other symptomatic approach. Methods: a prospective observational study, all the patients who were admitted to tertiary care hospital between October 2019 to September 2020 and developed Acute kidney injury were included. All the relevant data were collected from case reports and case sheets and patient interaction. Patients with the definitive history of renal disease, exposure to nephrotoxic drugs were excluded. All the statistical data were analyzed using descriptive statistics. Results: a total of 40 patients were included with a mean age of 40.07 (±10.01) years. This study shows a male predominance of 72.5% (n=29). The clinical manifestations like Cellulitis, local swelling, hypotension was commonly seen. Severe damage to kidney was seen in patients who received native medicine before admitting to hospital. Conclusion: this study concludes that acute kidney injury is one of the major causes of morbidity, there is need of education on snake envenomation and its treatment and first aid and effect of native medicine

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Int J Biol Med Res.2023 ;14(2):7566 - 7570
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Int J Biol Med Res
Volume 14, Issue 2, April 2023
Introduction:Snakebiteisconsideredtobeoneofthecommon,neglectedand
potential life-threatening public health issues in tropical and sub-tropical
countries. According to World Health Organization (WHO), 4.5- 5.4 million
people get bitten by snakes annually. Acute kidney injury is one of the major
health issues due to snake envenomation and can be managed with
appropriate dose of Anti-snake venom and other symptomatic approach.
Methods: a prospective observational study, all the patients who were
admitted to tertiary care hospital between October 2019 to September 2020
and developed Acute kidney injury were included. All the relevant data were
collected from case reports and case sheets and patient interaction. Patients
with the definitive history of renal disease, exposure to nephrotoxic drugs
were excluded. All the statistical data were analyzed using descriptive
statistics. Results: a total of 40 patients were included with a mean age of
40.07 (±10.01) years. This study shows a male predominance of 72.5%
(n=29). The clinical manifestations like Cellulitis, local swelling, hypotension
was commonly seen. Severe damage to kidney was seen in patients who
received native medicine before admitting to hospital. Conclusion: this study
concludes that acute kidney injury is one of the major causes of morbidity,
there is need of education on snake envenomation and its treatment and first
aidandeffectofnativemedicine.
Snake bite is considered to be one of the common,
neglected and potential life-threatening public health
issues in tropical and sub-tropical countries.
According to World Health Organization (WHO), 4.5-
5.4 million people get bitten by snakes annually. Of
this, 1.8–2.7 million develop clinical illness and 81,410
to 137,880 die from complications. India accounts for
2.8 million snakebites with fatal rate of 47,000 cases.
Farmers, fisherman, hunters, children and people in
endemic area are said to be more prone to get
envenomationduetocare.1,2
snakebite. The risk of mortality is more because of the
illiteracy or lack of education, due to the restriction in
the access of anti-snake venom and the false belief in
the rural area, victims end up with traditional
medicine or native medicine instead of reaching the
primary health Approximately 3000 species of snakes
are recognized world-wide out of which 600 are
poisonous and around 450 are dangerous for
humans.3 Most important species of snakes of India
include the so called “Big 4”, Russel’s viper (Daboia
russelli), Cobra (Naja naja), Common Krait (Bungarus
caeruleus) and Saw scaled viper (Echis carinatus) and
other snakes like hump nosed pit-viper (Hypnale
hypnale),theLevantineviper(Macroviperalebetina)

2. 7567
and others are now also considered to be medically
important includes humpnosed pit viper, green pit
viper,andsea-snake.4
Clinical presentation of envenomation includes
progressive painful swelling (Local necrosis,
Ecchymosis, Blistering, Painful swelling),
neuroparalytic (Ptosis, Diplopia, Dysarthia,
Dysphonia, Dyspnoea, Dysphagia, Paralysis),
vasculotoxic (Bleeding, Shock, Acute kidney injury),
myotoxic effects (Muscle ache, Muscle swelling,
Involuntarycontractionsofmuscles).5
Acute kidney injury is a seen in Viperidae groups,
sea snakes, and colubridae group. AKI is defined by an
abrupt decrease in kidney function. The common
laboratory findings include elevated serum creatinine,
urea, lactate dehydrogenase levels, hypercalcemia,
hyperkalemia,hyperuricemia.6AKIisoneofthemajor
causes for mortality among other complications.
Snakebite induced AKI can be managed with proper
administration of Anti-snake venom with other
supportivecare.
Thisstudyisaimedtobetterunderstandtheclinical
outline of patients developing AKI from snakebite and
its complications, effect of native medicine and
pharmacotherapyintertiarycarehospital.
Materialsandmethods:
A prospective observational study conducted at
tertiary care government teaching hospital in south
India for a duration of one year (October 2019 to
September 2020) after the study was reviewed and
approved by the Institutional Human Ethics
CommitteeofTheInstitution.
PatientsofeithersexadmittedtoIntensivecareunit
(ICU) and who stay for a minimum completion of 1 ICU
day. Patients with definitive history of snakebite (fang
marks), and who has developed AKI and patients
receiving ASV are included in the study. Patients with
existing renal disease or previous history of
hypertension and diabetes or under nephrotoxic
drugsareexcludedinthestudy.
All the relevant data of enrolled patients including
demographicdetailslikename,age,gender,clinical
data such as diagnosis, past medical history, co-
morbidities, days of therapy, usage of native medicine
was collected from the case sheets and patient’s
interaction.
The statistical data was analyzed using the Statistical
PackagefortheSocialSciences(SPSS)version25.0
Results:
A total of 40 patients were included who have
developed acute kidney injury, out of which 72.5%
male (n=29) and 27.5% female (n=11) were included
in the study. The demographic data and patient
characteristic studied are presented in (Table 1), 10
patients had the history of newly diagnosed
hypertension and 4 had a history of newly diagnosed
diabetes mellitus, no patients have taken nephrotoxic
drugs.Themeanageofthepatientswas40.07(±10.01)
and the patients of age group 31-40 and 41-50 years
were more likely to be bitten by snakes. Majority of the
patients have got bitten by snakes outdoor, an overall
of10%ofthepatientswereunawareaboutsnakebite.
The fang marks, multiple fang marks were seen in
almost all the cases. 17.5% of the snakebite were
encounteredbyElapidaespecies,35%ofthesnakebite
were encountered by Viperidae species whereas
47.5% of snakebite were unidentified as shown in
(table 1). All the patients that are included in the study
received Anti-Snake Venom after the admission with
an average of 15.5 vails as shown in (table-1) Clinical
manifestation of snakebite in patients showed
Cellulitis in 14 patients; local swelling in 20 patients; 2
patients have developed sepsis and 4 patients
developed hypotension as shown in (table 3). In the 40
patients 23 patients required dialysis and the
remaining 17 patients were treated as per standard
protocol. The laboratory investigation showed
elevated level of serum creatinine with the mean
4.91mg/dL. Among the 40 patients 8 patients received
native medicine before admitting to hospital had the
severe degree of AKI, the data showed a mean of 8.77
(±1.06) mg/dL (table-2). The average length of stay
wasfoundtobe5.1(±3.1)days(table-1).
Niranjan et al. /Int J Biol Med Res.14(2):7566 - 7570

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Discussion:
Snakebite poisoning is considered to be one of
the occupational hazards in rural areas, that
includes farmers, fisherman, daily wage workers,
plantation workers who lack the knowledge of
severity of snakebite. Snake venom is a complex
mixture of many different enzymes and
polypeptides, phospholipase A2 is broadly
studied out of all other venom enzymes, which
damages mitochondria, blood cells, peripheral
nerve endings, skeletal muscles and other
membranes. Elapidae and Viperidae class of
snakes mainly causes renal impairment.4
Snakebite induced Acute kidney injury is found to
be one of the underreported causes of morbidity
and mortality.7 The exact pathogenesis of
snakebite induced acute kidney injury isn’t well
established whereas the contributing factors like
disseminated intravascular coagulation, anemia,
direct nephrotoxicity of venom, tubular necrosis
and cortical necrosis are considered to be the root
cause.8
In our study a total of 40 patients were included
who have developed AKI the gender distribution
showed male 72.5% predominance as majority of
the working population in India are male and are
found actively working in the fields and outskirts
without any protective gears.4,7-10 snakebite is
common irrespective of age but in our study the
age group of 31-40 and 41-50 years were highly
involved and the mean length of study was
5.1±3.1, these results were quite similar to the
previous study conducted by Harshavardhan L
and his team conducted a similar study, where the
younger population of 20-40 years were involved
and the mean length of stay was 9 days with acute
renalfailurepatients.11
Niranjan et al. /Int J Biol Med Res.14(2):7566 - 7570

4. Serum creatinine is said to be one of the main
diagnostic criteria in renal failure patients in our
study the mean serum creatinine valve was found
to be 4.9mg/dL, with other diagnostic parameters
like oliguria, albuminuria, elevated blood profiles
with decrease hemoglobin levels. Cellulitis was a
common manifestation with local swelling. This
study shows that use of dialysis is associated with
reduced gher degree of acute kidney injury.
morbidity which was found similarin the previous
study by patil and his conducted a similar study,
where the study shows better survival with the
hemodialysiswiththedischargedpatients8.
Anti-snake venom is the only specific treatment
for the snake venom toxins. The dosage of anti-
snake venom varies as the degree of
envenomation.5 In our study an average of 15.5
vails were administered to the patients with
respect to their response. Many factors contribute
to the ineffectiveness of anti-snake venom like
allergy towards to anti-snake venom, delay in the
admission to the tertiary care hospital where time
is considered crucial as delay in time leads to
increase in nephrotoxic fraction of venom12,
native medicine like herbal remedies and
superstitions like mantras, application of snake
stones, due to the lack of knowledge and
unavailability of anti-snake venom in the primary
health care people end up with professional snake
bite healers, snake charmers and religious men13,
ourdatasuggeststhattheusageofnativemedicine
hasahigherdegreeofacutekidneyinjury.
Conclusion:
Snakebite is still a neglected occupational
hazard in tropical and sub-tropical countries.
Illiteracy and negligence play a major role in
worsening of the mortality in patients. Acute
kidney injury due to snake envenomation is one of
the major health concerns, native medicine has
shown more damage to kidney. The delayed
admission to the tertiary care hospital increases
the comorbidities and increases the risk of renal
failure. There is a need to educate the people in
rural area about the snakebite and its treatment
andfirstaid.
Acknowledgment:
We like to thank healthcare professionals of
Department of Nephrology and Department of
General Medicine for their kind suggestions and
co-operationforthestudy.
Funding:Nofundingsources
Conflictofinterest:Nonedeclared
Ethicalapproval:Thestudywasapprovedbythe
Institutional Ethics Committee (ref no: MMC EC
38/2020)
7569
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