CTRI

Snake bite is predominantly an occupational hazard in the tropical countries; Agriculture remains the principal means of livelihood for 58.4% of Indiaâ€™s population and for a considerable proportion of the population in developing countries Hence exposing this group to the potential risk of snake bite. Acute renal failure can occur with the bite of Any venomous snake and is more common with snakes of the viperine species. The worldwide published statistics on the incidence of acute renal failure following venomous snake bite are inadequate as a proportion of the victims resorting to traditional means of therapy

The Annual global mortality from snake bites is estimated at around 40000 Per year with around 10000 deaths occurring per year in India alone⁽¹⁾.

The incidence of Acute renal failure in India is 13-32% following viper bite.⁽⁴⁾ There is wide spread discrepancy with the data available on the Incidence of Acute Renal Failure in snake bite patients with envenomation.

The venomous snakes belong to 4 families Elapidiae, Viperidae, Hydrophiidea and Colubridea. Acute Renal failure is caused mainly by snakes of the Viperidae family (Russell Viper and Saw scaled Viper) which are common species in India.

STUDY DESIGN- is a descriptive study over a period of one year in Father Muller Hospital.

A minimum of 30 patients with history of snake bite will be studied over a period of one year

The following baseline investigations will be done

Hemoglobin, platelet counts, coagulation profile including clotting time using the twenty minute whole blood clotting test- 2ml of freshly drawn venous blood to be placed in a small glass vessel, it is to be left undisturbed for twenty minutes at ambient temperature after the elapsed period the vessel is to be tipped once. If the blood is still liquid and runs out it indicates the presence of incoagulable blood which is a positive sign of envenomation. Bleeding time using the dukes method, prothrombin time, partial thromboplastin time and fibrin degradation products. Biochemical tests for blood urea, blood creatinine, serum electrolytes, liver function tests, blood sugars, urine routine and microscopy, urine albumin

Patients will be evaluated for the related factors such as age, sex, concomitant diseases, drug intake and prior documented renal disease.

Coagulation parameters such as bleeding time, clotting time using the twenty minute whole blood clotting test will be repeated sixth hourly. Blood urea, blood creatinine and urine output will be monitored daily to detect Acute renal failure using the RIFLE criteria. Patients with a 3 fold rise of serum creatinine over the baseline value or a serum creatinine of more than 4mg/dl at the time of admission with an acute rise of more than 0.5 mg/dl, urine output less than 0.3ml/kg/hrx24 hrs, anuria lasting for more than 12hr and a GFR decrease of more than 75% will be considered as patients who developed Acute Renal Failure. The GFR will be calculated using the Cockroft Gault formula. Patients will be followed up for a period of three days to detect the occurrence of renal failure.