Snake bites are a major public health issue in India, with the highest mortality rate in the world according to WHO estimates of 83,000 bites and 11,000 deaths annually. There are 216 species of snakes found in India, of which 52 are poisonous. The main poisonous snake families are the elapidae which includes cobras, kraits, and sea snakes; viperidae which includes Russell's vipers, saw-scaled vipers and sand vipers. Snake venom is mostly proteins including enzymes, toxins, and neurotoxins. Clinical effects of snake bites vary and can be categorized into 5 syndromes based on symptoms - local envenoming, bleeding/clotting disturbances, paralysis, renal failure

1. SNAKE BITE
Dr Prasanna Deshmukh
Moderator – Col Yashpal Singh

2. • Highest snakebite mortality in the world.
• World Health Organization (WHO) estimates
place the number of bites to be 83,000 per
annum with 11,000 deaths.

3. Introduction
In the world
3000 species, 500 poisonous
In India
216 species, 52 poisonous
Annual mortality in India
5.6 to 12.6 per 100000

4. Venomous Snakes in India
Elapidae
Cobra
Common Krait

5. Common Krait

6. • Viperidae
Russell’s viper
Saw-scaled viper
Sand viper

7. • Colubridae
Pit viper

8. • Hydrophidae
Sea snakes

9. Features of poisonous and non
poisonous snake

12. Venom
• 90% of snake venom (dry weight) is protein.
• Each venom contains more than a hundred
different proteins: enzymes (constituting 80-
90% of viperid and 25-70% of elapid venoms).

13. Snake Venom
Common components
Procoagulant enzymes
Haemolytic toxins
Cytolytic / necrotic toxins
Myolytic toxin
Presynaptic neurotoxin
Postsynaaptic neurotoxin

14. Clinical Features
Dry bites
20% pit viper bite, 43% cobra bites
Local features
Fang marks
Pain
Swelling
Blistering & necrosis
Lymphangitis, lymphadenopathy
Secondary infection
Venom ophthalmia

15. Local effect of pit-viper bite

16. Local effect of a viper bite

17. General features
flushing
sweating
breathlessness, palpitation
tightness in chest
nausea, vomiting (in all severe envenoming)
acroparaesthesiae
hyper salivation, blurring of vision (cobra)
abdominal colic, diarrhoea, collapse ( krait)

18. SYNDROMIC APPROACH TO SNAKE
BITE
• Syndrome 1
• Local envenoming (swelling etc) with
bleeding/
• clotting disturbances = Viperidae

19. • Syndrome 2
• Local envenoming (swelling etc) with
bleeding/
clotting disturbances, shock or renal failure =
Russell’s viper (and possibly saw-scaled viper
– in some areas)
With conjunctival edema (chemosis) and acute
pituitary insufficiency = Russell’s viper
• With ptosis, external ophthalmoplegia, facial
paralysis etc and dark brown urine = Russell’s
viper

20. • Syndrome 3
Local envenoming (swelling etc) with paralysis =
cobra or king cobra
• Syndrome 4
Paralysis with minimal or no local envenoming
Bite on land while sleeping = krait
Bite in the sea = sea snake

21. • Syndrome 5
Paralysis with dark brown urine and renal
failure:
Bite on land (with bleeding/clotting disturbance)
= Russell’s viper
Bite in the sea (no bleeding/clotting
disturbances)
= sea snake

22. Reference
• Snake Bite : Indian Guidelines and Protocol
• WHO Guidelines for Snake bite

23. Thank you