Snake bites

Notes
  • People who work in the field have the greatest risk of snake bites.
  • The vipers are the most common group of snakes in Kenya while puff adders are responsible for most of the of snakebite and deaths.
  • There are four main classes of toxins found in snake venoms: neurotoxins, cytotoxins, cardiotoxins and hemotoxins.
  • Neurotoxins include the following:

*Fasciculins that destroy acetylcholinesterase causing tetany and death. They are found in mambas & rattlesnakes.

*Dendrotoxins that block the exchange of positive and negative ions across the neuronal membrane causing paralyzing and death. They are found in mambas.

*α-neurotoxins that fit to the Nicotinic acetylcholine receptors of cholinergic neurons causing paralyzing and death. They are found mainly in cobra and sea snakes.

  • Cytotoxins cause localized effect on the bite area and they include the following:

*Phospholipases that act on phospholipid molecule of the cell membrane leading to their rapture. Snake venoms also contain other hydrolytic enzymes that include proteinases and nucleotidases.

  • Cardiotoxins cause depolarisation of cardiac muscles and lead to death.
  • Haemotoxins cause hemolysis and blood coagulation. They are found mainly in cobra and vipers.
Symptoms
  • Collapse/syncope that may be characterized by death or spontaneous recovery.
  • Pain at the site of biting
  • Local tissue swelling
  • Tissue neurosis and sloughing off.
  • Hemorrhage (anticoagulant activity).
  • Sweating
  • Immobilization
  • Drowsiness
  • Slurring of speech
Diagnosis
  • Clinical examination e.g. presence of mark of fangs.
  • Monitor the international normalized ratio (INR), activated partial thromboplastin time (aPTT), full blood count (FBC), electrolytes, urea, creatinine, creatine kinase (CK, to detect myotoxicity) and lactate dehydrogenase (to detect haemolysis in thrombotic microangiopathy).
Management

Immediate action

  • Avoid washing and cutting of the bitten area and attempt to suck the venom
  • Immobilize the patient
  • Apply crepe bandage loosely over the bite area
  • Apply heavy bandage just above the fingers or toes of the bitten limb to the furthest point possible

Mangement in hospital

  • Treatment of wounds and symptoms.
  • Monitor the patient for at least
  • Anti-tetanus prophylaxis
  • Antivenom (in the Kenyan market):

*Inoserp Antivenom®, Inosan, inj., polyvalent antivenom against snakebite envenomation [10ml= Kes: 10,727.25]

Anti-snakevenom, Serum Institute, 10ml amp [10ml amp = Ke:3548.00].

*Snake venom Antiserum [African], Vins, equine immunoglobulin fragments [10ml vial = Ke:7,228.00].

Dose:  At least one vial is infused.

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