Uploaded byDR. METI.BHARATH KUMAR
CASE PRESENTATION ON SNAKE BITE
This case presentation summarizes the details of a 64-year-old male patient admitted to the hospital with a snake bite. The patient presented with swelling of the right lower limb, decreased urine output, and shortness of breath. Laboratory tests showed renal dysfunction. The patient was given anti-venom treatment, antibiotics, IV fluids, and supportive care. First aid measures and treatment protocols for snake bites are also outlined.
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CASE PRESENTATION ON SNAKE BITE
- 1. SAASTRA COLLEGE OFPHARMACEUTICAL EDUCATION AND RESEARCH Near Varigonda, Jwalamukhi Temple, Muttukur Road, Kakupalli, Nellore - 524 311 Andhra Pradesh, India Affiliated to JAWAHARLAL NEHRU TECHNOLOGICAL UNIVERSITY ANANTAPUR, ANANTAPURAMU CASE PRESENTATION ON SNAKE BITE SUBMITTED BY METI.BHARATH KUMAR 16DK1T0014 Pharm.D INTERNSHIP
- 2. DEMOGRAPHIC DETAILS • NAME:Dhanamiah • AGE: 64 years • GENDER: male • DEPARTMENT:General medicine • UNIT:MM-7 • IP NO : 69363 • DOA:18/12/2021 • CONSULTANT PHYSICIAN: Dr.M.Maheswar reddy M.D
- 3. SUBJECTIVE EVIDENCE • A64 years old male patient was admitted in a male medical unit MM- 7 with the chief compaints of, snake bite at right foot @5.00 PM yesterday burning sensation of both lower limbs swelling of right lower limb since yesterday decrease urine output Shortness of breath
- 4. OBJECTIVE EVIDENCE • COMPLETEBLOOD PICTURE: HGB: 10.4 RBC: 3.78 WBC:11.2 PLT:47 B.urea: 244 mg/dl Serum.creatinine: 8.3 PT time: 42.0 sec INR: 3.7 • Serum calcium: 7.5 mg/dl • Total proteins: 5.4 gm/dl • Serum albumin: 2.9 gm/dl Lipid profile test: • Cholesterol : 138 mg/dl • Triglycerides: 143 mg/dl • HDL: 26 mg/dl • LDL: 83 mg/dl • VLDL : 29 mg/dl
- 5. PLAN OF TREATMENT MONITORVITALS DAY 1 o/E • Pt: c/c • Temp:afebrile • RR:20/min • PR:84/min • BP: 150/90 mm hg • RBS:47 mg/dl • CVS: s1s2 +ve • RS: BAE + • U.O: nill Rx • 1.inj.ASV 10 vials in 1unit 5 % D IV over 1 ½ hour • 2.inj.amoxy 1.2 gm IV BD • 3.inj.metrogyl 100 ml IV TID • 4.IVF 25% D IV after that IVF 5% D IV • 5. 1 unit DNS and 1 unit NS @ 20 ml/hour slowly • 6.t.telma 40 mg OD • 7.t.chymoral forte TID • 8.inj.pantop 40 mg IV OD • 9.again inj.ASV 10 vials in 400 ml NS IV over 1 hour
- 6. PLAN OF TREATMENT MONITORVITALS DAY 2 o/E • Pt: c/c • Temp:afebrile • RR:20/min • PR:90/min • BP: 150/90 mm hg • RBS:47 mg/dl • CVS: s1s2 +ve • RS: BAE + • U.O: nill Rx • 1.FFP 2 unit • 2.inj.amoxy 1.2 g in 100 ml NS IV • 3.inj.metrogyl 100 ml IV TID • 4.inj.pantop 40 mg IV OD • 5.t.chymoral forte TID • 6.t.telma 40 mg OD • 7.RBS 8 th hourly • 8. IVF – 25 % D BD
- 7. DRUG CHART S.NO GENERICNAME BRAND NAME INDICATION DOSE ROA FREQUENCY 1 Amoxicillin+potassium amoxyclav Reduce infection 1.2 g IV BD 2 pantoprazole Pantop Reduce acidity 40 mg IV OD 3 metronidazole Metrogyl Kill bacteria 100 ml IV TID 4 Trypsin+chymotrypsin Chymoral forte Promote healing 15000 0units PO TID 5 Telmasartan telma Bp control 40 mg PO OD 6 Each ml contain: Indian cobra venom Common krait venom Russeli’s viper venom Saw scaled viper venom Anti snake venom Antidote for venom 10 ml IV BD
- 8. PHARMACEUTICAL CARE ISSUES •No pharmaceutical care issues found the prescription was rational.
- 9. DISCUSSION • A bitefrom a venomous snake is rarely deadly - about 6 fatalities are reported every year -but it should always be treated as a medical emergency. Even a bite from a harmless snake can be serious, leading to an allergic reaction or an infection. Venomous snake bites can produce an array of symptoms, including localized pain and swelling, convulsions, nausea, and even paralysis. • First aid steps you can take after a snake bite occurs include cleaning the wound, remaining calm, and immobilizing the affected area.
- 11. CLINICAL MANIFESTATIONS • twopuncture wounds • swelling and redness around the wounds • pain at the bite site • difficulty breathing • vomiting and nausea • blurred vision • sweating and salivating • numbness in the face and limbs
- 13. FIRST AID FORSNAKE BITE • Call 911 immediately. • Note the time of the bite. • Keep calm and still as movement can cause the venom to travel more quickly through the body. • Remove constricting clothing or jewelry because the area surrounding the bite will likely swell. • Don’t allow the victim to walk. Carry or transport them by vehicle. • Do not kill or handle the snake. Take a picture if you can but don’t waste time hunting it down.
- 14. TREATMENT • The mostimportant thing to do for a snake bite is to get emergency medical help as soon as possible. • A doctor will evaluate the victim to decide on a specific course of treatment. • In some cases, a bite from a venomous snake is not life-threatening. • The severity depends on the location of the bite and the age and health of the victim.
- 15. SPECIFIC TREATMENT: • Usepolyvalent ASV, which is most effective in the first four hours.ASV can be given upto 24 hours or even longer. • Inj.hydrocortisone 200 mg and pheneramine maleate (Avil) one amp to be given IV prior to the administration of ASV to avoid allergic reactions. DOSE OF ASV: local resction only: 4 vials of ASV in 500 ml 5% D IV over 4 hours Local reaction with severe cellulitis: 4 vials in first 2 hours and 4 vials in next 4 hours. On an average 4-16 vials of ASV are required .
- 16. SUPPORTIVE TREATMENT: Respiratory paralysis:high flow oxygen with nasal prongs. Anticholinergics: if neuromuscular paralysis present use atropine 1.2 mg IV and neostigmine 1 mg IV stat and repeat every half an hourly then taper this combinations into 1,2,3,4th hourly and then stop when patient’s condition improves. Acute renal failure: conservative management Antibiotics: Ampicillin 1 g IV Q6H Pain : chymoral forte Q8H or tramadol 500 mg BD Bleeding: arrange fresh blood transfusion. Severe cellulitis : surgical debridement of the wound and fasciotomy may be needed followed by skin grafting.
- 17. PREVENTION • It’s bestto refrain from approaching or handling snakes in the wild. • Avoid typical places where snakes like to hide, such as patches of tall grass and piled leaves, and rock and woodpiles. • When working outside where snakes may be present, wear tall boots, long pants, and leather gloves. • Avoid working outside during the night and in warmer weather, which is when snakes are most active.