Treatment Approach for Snake Bites in India
For snake bites in India, the recommended treatment approach includes immediate immobilization of the bitten extremity, removal of constricting jewelry, prompt administration of polyvalent antivenom against the "Big Four" snakes, and supportive care with close monitoring for complications. 1
Initial Management
- Call emergency services immediately
- Rest and immobilize the bitten extremity
- Remove constricting jewelry
- Do NOT apply:
- Ice
- Suction devices
- Electric shock
- Tourniquets
- Pressure immobilization bandaging (for Indian snakes) 1
Antivenom Administration
- Polyvalent antivenom (PAV) is the primary therapy for snake bites in India
- PAV is available against the "Big Four" snakes:
- Initial dose of 4-6 vials should be administered as soon as possible after envenomation
- Additional doses may be required until initial control is achieved 1
Monitoring and Supportive Care
- Monitor patient for at least 1 hour after initial antivenom dose
- Initial control is achieved when:
- Local injury progression stops
- Systemic symptoms resolve
- Coagulation parameters normalize or trend toward normal 1
- Monitor for recurrent coagulopathy for at least one week following treatment
- Perform laboratory monitoring:
- Complete blood count
- Coagulation studies
- Renal function tests
- Electrolytes 1
Management of Complications
- For respiratory compromise:
- Early intubation and mechanical ventilation at first sign of respiratory distress
- Monitor oxygen saturation and provide supplemental oxygen if hypoxic 1
- For renal complications:
- Aggressive fluid resuscitation with normal saline (initial rate 1000 ml/h, then tapered by at least 50% after 2 hours)
- Avoid potassium-containing balanced salt fluids due to risk of hyperkalemia
- Consider emergency dialysis for life-threatening hyperkalemia, severe metabolic acidosis, volume overload with pulmonary edema, or uremic complications 1
Long-term Follow-up
- Essential for all snake bite patients
- Up to 41% of patients may show persistent renal involvement
- Risk of progression to chronic kidney disease in approximately 5-20% of cases 1
Important Considerations and Limitations
- Current Indian polyvalent antivenoms show significant batch-to-batch variations and varying efficacy 3
- The commercially available antivenoms may have limited efficacy against venoms from snakes outside the "Big Four" and against regional variants of the same species 4
- Mortality rate from snake bites can be significantly reduced with prompt medical intervention, particularly early respiratory support and antivenom administration 1
Specialized Care
- Patients with severe envenomation should be treated in specialized centers with experience or under consultation with expert centers
- Contact with specialized centers is essential for guidance in complex cases 1