# “Fanged to Peril”: Interesting Snake Bite Case Series

## TL;DR

This paper presents a case series of five snakebite patients with varied clinical presentations and management strategies in an emergency department.

## Contribution

The study provides a detailed case series on the emergency management of snakebite complications, which is not well documented in the literature.

## Key findings

- Patients required anti-snake venom and additional interventions like renal replacement therapy and coagulopathy management.
- Management strategies included mechanical ventilation, neurotoxicity treatment, and compartment syndrome handling in pregnancy.
- Early recognition and timely administration of anti-snake venom were critical for effective outcomes.

## Abstract

Snakebite is an acute life-threatening medical emergency and is included among the neglected tropical diseases in India. The incidence of snakebite mortality is particularly high in Southeast Asia and India has the highest number of cases of snakebites with a mortality of 35,000 to 50,000 cases per year according to the World Health Organization (WHO) direct estimation. There are three families of venomous snakes in Southeast Asia which mainly include Elapidae, Viperidae, and Colubridae. Snakebite victims show varied clinical presentations ranging from local signs to systemic signs of envenomation. WHO has detailed five syndromes based on various clinical presentations and the most probable family of snakes responsible for that syndrome. There are several cases reported on the initial clinical presentations in the literature; however, case series which include the presentation to ER, the hospital course, and management of complications have not been published in the literature. Following is a case series of five patients of diverse age groups who presented to the Emergency Medicine Department (ED) with a wide spectrum of clinical presentations, diverse clinical courses, and management strategies. These patients not only required the administration of anti-snake venom in the ED but also required additional interventional modalities including renal replacement therapy for acute kidney injury and biopsy-proven acute tubular necrosis, viper-induced consumptive coagulopathy, management of coagulopathy in pediatrics, management of compartment syndrome in pregnancy, mechanical ventilation for respiratory failure and management of neurotoxicity. We hereby emphasize that early recognition of signs of envenomation and early administration of anti-snake venom is imperative in the initial management of snakebites along with the monitoring of a snakebite victim for complications and timely management of the same.