Clinical trial of intramuscular anti-snake venom administration as a first aid measure in the field in the management of Russell's viper bite patients.

Efficacy of intramuscular anti-snake venom administration immediately after bite as a first aid measure in the field followed by standard hospital management versus standard hospital management alone in the therapy of Russell's viper bite patients was studied. There was a definite reduction in the number of patients with systemic envenomation, complications following disseminated intravascular coagulation and in fatality rate of Russell's viper bite victims who had received first aid intramuscular anti-snake venom prior to hospitalization when compared with those who had not.

Heparin therapy in Russell's viper bite victims with disseminated intravascular coagulation: a controlled trial.

A controlled clinical trial of low dose heparin was carried out in confirmed cases of Russell's viper bite. Twenty patients with systemic envenoming were included in the study. They were randomized to receive low dose heparin in an initial dose of 50 units/kg body weight intravenously immediately after antivenom followed by a continuous infusion of 10 unit 3 kg/hour in isotonic saline for 24 hours, or antivenom alone. Response to treatment was assessed clinically as well as by serial measurements of coagulation factors and biochemical values. No significant difference was observed in the outcome among two groups, the recovery rate from the clotting defect being similar in both. The mean serum creatinine values of the two groups were also not statistically different. The results indicated that there is no beneficial effect of adding heparin to the standard treatment by antivenom.

The effect of cigarette smoking on nasal mucociliary activity

Nasal mucociliary transport rates of healthy twenty male non-smokers and twenty cigarette smokers (20-39 years) were measured using Saccharin Crystal Technique by Proctor (1973). The mean nasal mucociliary transport rate of non-smokers was found to be 10.17 mm/min. with a range of 8.78 to 12.22 mm/min. and that of cigarette smokers was 7.95 mm/min ranging from 7.04 mm/min. Significant decrease (p<0.0010 in nasal mucociliary transport rate was observed in cigarette smokers.

Serum haptoglobin levels in Russel's viper bite victims

Serum haptoglobin levels of proven Russell's viper bite victims were studied at various time intervals after the bite. Although some degree of hemolysis was observed, there was no complete situation of haptoglobin with hemoglobin in these patients.This indicates that hemoglobinuria induced renal damage can be excluded as a major cause of Russell's viper venom nephropathy in systemicenvenoming patients.

Interrelationship among glomerular filtration rate, fractional sodium excretion and albuminuria in Russell's viper bite patients

The interrelationship among Ccr, FENa percent and Ualb were observed in 38 Russell's viper bite patients for 5-days clinical course. Degree of albuminuria had strong hyperbolic relation with glomerular filtration rate (Ccr) on day 1 after bite but not from day 2 onwards. The extent of albuminuria and fractional sodium excretion (FENa per cent) level was found to indicate the severity of renal insult. Albuminuria (Ualb) was associated with impaired Ccr and renal sodium handling. Ccr value below 40 ml/min or albuminuria (Ualb) above 2.07 g/24 hr on day 1 after bite was found in oliguric renal failure patients.

Patterns of acute renal failure in Russell's viper bite patients

Fifty-two patients with acute renal failure due to Russell's viper bite were studied. 34 patients had oliguric and 18 had non-oliguric types of acute renal failure. There was a higher incidence of complications such as gastrointestinal bleeding, renal angle tenderness and facial oedema in patients with oliguria. These patients also had a higher serum creatinine, fractional excretion of sodium and renal failure index when compared to polyuric patients. Mortality rate was about 32 per cent inpatients with oliguria in spite of peritoneal dialysis in 8 patients. No patients in the polyuric group needed dialysis and none died. The difference may be due to more severe renal lesions in patients with oliguric acute renal failure.