Complications of hemotoxic snakebite in India

Abstract

Hemotoxic snakebite is the major cause of mortality and morbidity in India in victims of venomous snakebite. The hemotoxic species in India include the Russell’s viper, saw-scaled viper, and various pit viper species. The major complications related to hemotoxic snakebite, other than bleeding manifestations, which could occur anywhere from the bite site, mucosal membranes, serous cavities, and organs, include life-threatening ones like acute kidney injury (AKI), acute respiratory distress syndrome (ARDS) or its lesser variant acute lung injury (ALI), disseminated intravascular coagulation (DIC), and capillary leak syndrome (CLS). Mortality secondary to hemotoxic snakebite is high with complications like ARDS and CLS. The prolonged hospital stay and mortality in hemotoxic snakebites as compared to Elapidae bites are mostly related to the multiorgan involvement seen in hemotoxic snakebites which is not seen in Elapidae bites. The long-term complications related to hemotoxic snakebite include amputations and limb deformities, hypopituitarism, osteomyelitis, squamous cell carcinoma at sites of nonhealing ulcers, sequelae of acute coronary syndromes like left ventricular dysfunction, and sequelae of stroke like limb weakness or cognitive impairment.