Acute respiratory failure following neurotoxic snake bite - A study of 101 cases of neurotoxic snake bite from eastern India

Introduction: Snake bites are most feared occupational hazard encountered by farmers,Plantation Workers,Herdsmen so also rural population with case fatality rate from 1.7% to 20%Chippaux JP, 1998. Aims: To study the clinical profile and factors related to ARP(acute respiratory failure) following NSB(neurotoxic snake bite). Materials and Methods: Obtaining permission from IEC and patient9s relatives,we conducted a prospective observational study of patients of NSB over one year. Results: We came across 101 adult patients of NSB,Kraits 71 and Cobras 30 The physical findings are Bilateral Ptosis 101 (100%),Muscle tenderness 83 (82.1%) and ARP 60 (59.4%). All are treated with ASV and MV(Mechanical Ventilation). Among the respiratory paralysis patients only 20(33.33) reached hospital within 2 hours of the snake bite and they were put on MV for 24 hours and all improved. Twenty four patients(40%) reached hospital after two to six hours of NSB,they all improved but given Avg. more ASV(35 vials v/s 25 vials) and more length of MV(48 hours) rest 16 patients (26.67%) could reached hospital after six hours of NSB,out of which 8(50%) survived and duration of MV was more than 72 hours. Conclusion: Most important factor predicting mortality in NSB is delay in hospitalization. Major cause of death is ARP.Hypotension & Sepsis.