Open AccessA Study of Acute Kidney Injury among the Patients with Snakebite in a Tertiary Care Hospital
Author(s) -
Kadubandi Sunil Kuma
Publication year - 2021
Publication title -
journal of advanced research in medicine
Language(s) - English
Resource type - Journals
eISSN - 2394-7047
pISSN - 2349-7181
DOI - 10.24321/2349.7181.202117
Subject(s) - medicine , acute kidney injury , dialysis , disseminated intravascular coagulation , creatinine , mortality rate , surgery , intensive care medicine
Background: The clinical presentation of a snakebite victim varies with the age and size of the patient, the species of snake, the number and location of the bites, the quantity and toxicity of the venom. The exact pathogenesis of Acute kidney injury (AKI) following snakebite is not well established, due to the lack of a reproducible animal model. The factors that may contribute are:direct cytotoxicity, bleeding, hypotension, circulatory collapse, intravascular hemolysis, disseminated intravascular coagulation and microangiopathic hemolytic anemia (MAHA). Objective:To analyze various factors, influencing the outcome in patients of snakebite with acute kidney injury. Materials and Method: The present prospective study was conducted in the Department of Emergency Medicine at M S Rammaih Medical College Bengaluru from August 2017 to September 2018. A total of 100 study subjects who met the inclusion criteria (patients with history of snakebite presenting with acute kidney injury) were included in the study. Patients underwent physical examination daily. Pulse rate, blood pressure, urine output, respiratory rate and features of envenomation were monitored daily. Blood specimen was taken every day till discharge or death to measure sodium, potassium, urea, creatinine, bleeding time, clotting time, platelets and for patients undergoing dialysis, pre-dialysis and post-dialysis urea and creatinine was measured for each cycle. Results: Age, Gender, and Presence of Cellulitis does not influence the mortality in patients with Acute Kidney Injury. Early therapy with Anti-snake venom was associated with better outcome in terms of mortality. Early institution of dialysis had definite favourable outcome in Acute Kidney Injury. All patients with Acute Kidney Injury showed autopsy findings of renal involvement. Conclusion: In the present study, viper bite accounted for definite acute kidney injury. Major risk factors linked with adverse outcome in snakebite with Acute Kidney Injury were hypotension, bleeding manifestations and delayed specific therapy with anti-snake venom.