. Analgesics and antipyretics (tabkt mefanemic acid

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1 Inti. Chem. Phalli!. Med. J. Vol. 1(2), pp (2004) STUDY OF SNAKEBITE CASES ADMITTED IN NPCC, KARACHI FROM JANUARY 1999 TO DECEMBER 2002 Aftab Turabi1, Mansoor Ahmad2 and Kamran Ahmad Chishti3 J National Poison Control Center, Jinnah Hospital, Karachi, Pakistan. 2Researcl1 Institute of Pharmaceutical Sciences, Depanment of Pharmacognosy, Faculty of Pharmacy, University of Karachi, Karacl1i-75270, Pakistan 3Depa/111lent of Pl1annaceutical Chemistry, Faculty of Pharmacy, University of Karachi, Karachi-75270, Pakistan ABSTRACT: Snakebite cases studied from 1999 to 2002 constitutes 4.64% of total poisoning admitted in NPCC and had male female ratio of84.14%: 15.86%. The snakes identified in the study period were classified as elapidae (130), viperidae (63), hydrophiidae (6), and nonvenomous (28). Various complications were observed that include gastrointestinal bleed (13), hematuria (6), jaundice (4), renal failure (5), intra-cranial bleed (2), and respiratory depression (3). The investigations revealed that 102 patients showed. reduced hemoglobin concentration and raised leukocyte count Altered liver enzymes were seen in 138 patients where as urea and creatinine were increased in 95 and 50 patients respectively. Bleeding tendencies and coagulation defect was seen in 147 and 94. Urine examination revealed hematuria, and protein urea in 71 victims. The outcome of treatment was varied from snake to snake. 130 patients of elapidae bite showed 122 recoveries and 8 deaths. Among Viperidae bite of 63 patients, 48 were recovered, and 15 had died. There were 6 cases of hydrophiidae bite, in which 2 were died while 4 were recovered. 28 cases of non-venomous snakebite showed 100% recovery. Overall outcome of showed 25 deaths that constitutes (11.01 %). There was complete recovery of 202 patients (88.99%) that had male/female ratio of 171: 31. INTRODUCTION Venomous or poisonous animals are found in all the animal classes except birds. These poisonous animals are widely distributed in the animal kingdom from the unicellular protistan to chordates. Venomous animals are found in almost all seas and oceans and on all the Continents. There are approximately 1200 species of poisonous marine animals, the number of venomous arthropods is countless, and there are some 375 species of snakes considered dangerous to humans (Casarett and Doull'sI992). Both venomous and nonvenomous snakebite cases were observed during the study. In this study we have tried to explore the every aspect of the incidence that may help in reducing the morbidity and mortality. Venomous terrestrial snakes of Pakistan belong to three families; Elapidae (Cobras and Kraits); Viperidae (True vipers); and Crotalidae (Pit vipers). Pit vipers are confined to Himalayas Mountain and therefore not encountered in our study. However as Karachi is a coastal city we experienced some snakebite cases from sea as well (Khan and Tasnim Khan 1983). Chain viper's bite is one of the most dangerous among Pakistani snakes and is strongly blood coagulant and causes extensive bleeding (Khan 1980). Various snake species of the Pakistan coastal waters are annulated sea snake (hydrophis cyanocinctus), yellow sea snake (hydrophis spiralis), Persian Gulf sea snake (hydrophis lapemoides), oriental small-headed sea snake (hydrophis fasciatus), graceful small-headed sea snake (Microcephaphis gracilis), beaked sea snake (Enhyrina schistosa), and pelagic sea snake (Pelamis platurus) (Khan 1980). MA TERIALS AND METHODS Materials:. Patients (snake bite cases reported to NPCC from 1999 to 2002). Anti-snake venom (polyvalent ASV, available in 10ml vial, prepared by NIH). Antibiotics (given by I/V route in case of bad wound or as required). Analgesics and antipyretics (tabkt mefanemic acid or ibuprofen). Dressing (aseptic dressing at the site of bite) Method: We have studied 227 cases of snakebite from 1999 to 2002 at NPCc. They were presented with variable signs and symptoms depending upon the variety of snake to which they had exposed. The parameters that we had included in this study were age., gender. time and site of incidence. site of bite. clinical presentations. laboratory investigations. treatment and 123

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7 Study of Snakebite Cases Admitted in NPCC lilt/. Chem. Pharoz. Med. J. Dubois, KP. and Geiling, E.M.K Food Poisoning; Plant and Animal Poisons In: Dubois, KP. and Geiling, E.M.K Textbook of Toxicology. Oxford University Press. New York 1959; pp Forbes, CD., Turpie, AG.G., McNicol,. GP., Douglas, AS. Studies on East African snakes; Mode of action of Echis carinatus' venom. Scot. Med. J. 1966; 11: Khan, M.S. and Tasnim, R. Balling and caudal luring in young Bungarus caeruleus. The Snake, 1986; 18: Khan, M.S. Affinities and Zoogeography of the Herptiles of Pakistan. Biologia, 1980; 26(1-2): Khan MS. Venomous terrestrial snakes of Pakistan. The Snake, 1983; 15: Manson-Bahr, P.H. Animal poisons In: Manson's Tropical Diseases. 15th Edition. Cassel and Company, London 1960; pp Minton, S.A Jr. Paraspecific protection by elapid and sea snake antivenin. Toxicon, 1968; 5: Minton, S.A Jr. Snake bite In: Cecil Locbis Text Book of Medicine. 12th edition. Edited by Beeson, P.B. and McDermott, W.B. Saunders Company. Philadelphia 1968; pp Morris, R., Morris, D. Men and Snakes McGraw-Hill, New York. Muneer, AH. Survey of the species of snakes found in Pakistan.A.F.Med.J. 1969; XIX (1):1-19 Parrish, H.M. Snake venom poisoning. Medical Times 1961; 89: Reid, H.A Symptomatology, pathology and treatment of land snake bite in India and South East Asia In: Venomous Animals and their venoms. Reid HA (ed.) Vol. 1. Academic Press. New York 196. Manuscript submitted on July 5,2004 Accepted for publication July 15,