Syndromic approach to treatment of snake bite in Sri Lanka based on results of a prospective national hospital-based survey of patients envenomed by identified snakes

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1. Am J Trop Med Hyg. 2009 Oct;81(4):725-31.

Syndromic approach to treatment of snake bite in Sri Lanka based on results of a 
prospective national hospital-based survey of patients envenomed by identified
snakes.

Ariaratnam CA, Sheriff MH, Arambepola C, Theakston RD, Warrell DA.

Department of Clinical Medicine, Faculty of Medicine, University of Colombo,
Colombo, Sri Lanka. ariaranee2000@yahoo.com

Of 860 snakes brought to 10 hospitals in Sri Lanka with the patients they had
bitten, 762 (89%) were venomous. Russell's vipers (Daboia russelii) and
hump-nosed pit vipers (Hypnale hypnale) were the most numerous and H. hypnale was
the most widely distributed. Fifty-one (6%) were misidentified by hospital staff,
causing inappropriate antivenom treatment of 13 patients. Distinctive clinical
syndromes were identified to aid species diagnosis in most cases of snake bite in
Sri Lanka where the biting species is unknown. Diagnostic sensitivities and
specificities of these syndromes for envenoming were 78% and 96% by Naja naja,
66% and 100% by Bungarus caeruleus, 14% and 100% by Daboia russelii, and 10% and 
97% by Hypnale hypnale, respectively. Although only polyspecific antivenoms are
used in Sri Lanka, species diagnosis remains important to anticipate
life-threatening complications such as local necrosis, hemorrhage and renal and
respiratory failure and to identify likely victims of envenoming by H. hypnale
who will not benefit from existing antivenoms. The technique of hospital-based
collection, labeling and preservation of dead snakes brought by bitten patients
is recommended for rapid assessment of a country's medically-important
herpetofauna.

PMID: 19815895 [PubMed - indexed for MEDLINE]