Published: 2018-09-24

A 6 months retrospective observational study to assess the rationality and effectiveness of snake bite management in a tertiary care teaching hospital of rural Bengal, India

Satrajit Dan, Ananya Mandal, Abhijit Das, Sourav Chakrabarty, Tanmoy Gangopadhyay


Background: Snake envenomation is a common life-threatening problem encountered all-over West Bengal particularly in the rural areas. There are a large number of patients attending the Emergency unit and being admitted to the Medicine ward, some in the intensive care unit (ICU) and intensive therapy unit (ITU) of the tertiary health care facilities. The objective of this study was to assess rationality and effectiveness of management of venomous snake bite following standard protocol – Standard treatment guidelines of Government of West Bengal and National snakebite management protocol of Government of India.

Methods: This was a retrospective observational study of six months (May - October 2017) duration. Data were collected from the treatment records of patients admitted with history of snake bite in the Medicine ward, ICU and ITU of tertiary care teaching hospital of rural Bengal.

Results: Of the 63 venomous bite patients, most (82.5 %) were diagnosed to have features of neurotoxic envenomation. All of them (100%) received anti-snake venom (ASV). There was no incidence of anaphylactic reaction as well as any serious adverse drug reaction following ASV administration. Two patients developed acute renal failure, needed haemodialysis. Overall percentage of mortality was 3.2%.

Conclusions: The survival rate in venomous snake bite is found to be high in this institution. The practice of snake bite management is found to be adherent with standard protocol. A multicentric study of longer duration is suggested to draw a firm conclusion.


Antisnakevenom serum (AVS), Snake envenomation, Snake bite management protocol, Snake bite

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Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Snakebite Mortality in India: A Nationally Representative Mortality Survey PLoS Negl Trop Dis. 2011;5:e1018.

Brunda G, Sashidhar RB. Epidemiological profile of snake-bite cases from Andhra Pradesh using immunoanalytical approach. Indian J Med Res. 2007;125:661-8.

Chippaux JP. Snake-bites: appraisal of the global situation. Bull World Health Organ. 1998; 76: 515–24.

Standard Treatment Guidelines. Management of Snakebite; January 2016. Ministry of Health and Family Welfare. Available at: Accessed 27th July 2018.

Standard Treatment Guidelines for Primary Healthcare facilities. Institute of Health and Family Welfare, Kolkata West Bengal. Available at: Accessed 27th July 2018.

Kulkarni ML, Anees S. Snake venom poisoning: Experience with 633 cases. Indian Pediatr. 1994;31:1239-43.

Bawaskar HS, Bawaskar PH. Profile of snakebite envenoming in western Maharashtra, India. Trans R Soc Trop Med Hyg. 2002;96:79-84.

Punde DP. Management of snake-bite in rural Maharashtra: A 10-year experience. Natl Med J India. 2005;18:71-5.

Bawaskar HS, Bawaskar PH, Punde DP, Inamdar MK, Dongare RB, Bhoite RR, et al. Profile of snakebite envenoming in rural Maharashtra, India. J Assoc Physicians India. 2008;56:88-95.

Simpson ID, Norris RL. Snake antivenom product guidelines in India: the devil is in the details. Wilderness Environ Med. 2007;18:163-8.

Sharma SK, Khanal B, Pokhrel P, Khan A, Koirala S. Snake bite reappraisal of the situation in eastern Nepal. Toxicon. 2003;41:285-9.

Isbister GK. Snake antivenom research: the importance of case definition. Emerg Med J. 2007;22:399-400.

Simpson ID, Norris RL. Snakes of medical importance in India: is the concept of the Big 4 still relevant and useful? Wilderness Environ Med. 2007;18:2-9.

Rabies and envenomings: a neglected public health issue: report of a consultative meeting, World Health Organization, Geneva; 10 January 2007. Available at: Accessed 27th July 2018.

Simpson ID, Norris RL. The global snakebite crisis–a public health issue misunderstood, not neglected. Wilderness Environ Med. 2009;20:43-56.

Simpson ID. A study of the current knowledge base in treating snake bite amongst doctors in the high-risk countries of India and Pakistan: does snake bite treatment training reflect local requirements? Trans R Soc Trop Med Hyg. 2008;102:1108-14.

Sharma SK, Chappuis F, Jha N, Bovier PA, Loutan L, Koirala S. Impact of snake bites and determinants of fatal outcomes in southeastern Nepal. Am J Trop Med Hyg. 2004;71:234-8.