The analysis of 46 fatal snake bite cases in Thailand.

ABSTRACT

In order to identify aspects of snake bite treatment which could be improved, 46 well-documented cases of fatal snake bite (mortality rate = 2.8%) from 15 provincial hospitals throughout Thailand were selected for analysis (1,626 bites in 84 hospitals). Bungarus candidus and Calloselasma rhodostoma were each responsible for 13 deaths, Naja kaouthia for 12, Vipera russelli for seven and Bungarus fasciatus for one. Major causes of death were respiratory failure and complications of prolonged mechanical ventilation following Elapidae bites; shock, intracranial haemorrhage, complications of local wound necrosis including tetanus, and renal following Viperidae bites. Analysis of these patients’ clinical management revealed the following factors contributing to fatal outcome: inadequate dose of antivenom (15 cases), inappropriate specificity of antivenom (12 cases), inadequate mechanical ventilation (10), late arrival at hospital after traditional treatment (10 cases), artificial ventilation not attempted despite respiratory failure (8), inadequate treatment of hypovolemia including tetanus (6), obstruction of endotracheal or tracheostomy tube (5) and transfer between hospital (5), the treatment of snake bite must be directed both to medical staff and potential patients, particularly the high risk groups in rural areas. This study was supported in part by the Wellcome Trust of Great Britain under the Wellcome-Mahidol University, Oxford Tropical Medicine Research Programme.