High-dose anti-snake venom versus low-dose anti-snake venom in the treatment of poisonous snake bites--a critical study.

OBJECTIVES: To asses the optimum dose of anti-snake venom to treat snake bites cases effectively. This is particulary relevant in the present scenario when the cost of anti-snake venom ( Serum Institute of India) has gone up to nearly Rs. 400 per vial and the cross-section of people usually affected belong to the poor socioeconomic class. METHODOLOGY: One hundred snake bite cases with envenomation, irrespective of whether they were bitten by viper, cobra or krait, brought within 24 hours of the bite to Jubilee Mission Hospital, Trichur, Kerala State during the 15 months from August 2001 to October 2002 were randomized into two groups of 50 cases each, irrespective of the severity of the cases. One group received a fixed dose regime of six vials of anti-snake venom and the other 12 vials of the same. RESULTS: In the low-dose group there were five deaths giving a mortality rate of 10%, nine (18%) required dialysis and three (6%) required ventilatory support. In the high-dose group there were seven deaths giving a mortality rate of 14%, 13 (26%) required dialysis and three (6%) required ventilatory support. The average hospital stay for the low-dose group was 8.42 days while that of the high-dose group was 9.02 days. CONCLUSION: While there was no additional advantage in following a high-dose regime for snake bite cases, there was considerable financial gain by following the low-dose regime, Most of the parameters showed a beneficial trend for the low-dose group though the differences were not statistically significant.

Trial of heparin in viper bites.

AIMS OF THE STUDY: Viper bites produce hematotoxicity and coagulopathy which may be either true disseminated intravascular coagulation (DIC) or DIC-like syndrome. Role of heparin is studied in the present study of viper bite cases as use of heparin provides a rational therapy for defibrination caused by viper envenomation. METHODOLOGY: One hundred and twenty two patients with viper bite and incoagulable blood were randomised into test group and control group. Test group received heparin in addition to antisnake venom (ASV). Efficacy was assessed by monitoring bleeding time (BT), clotting time (CT), prothrombin time (PT), platelets, fibrinogen, blood urea (BU), serum creatinine, development of complications and overall outcome. RESULTS: Heparin group showed favourable outcome in all parameters studied. But many of them were not statistically significant. CONCLUSION: Heparin seems to be having a beneficial role which needs to be confirmed by larger trials and longer duration of heparin administration.