Profile of snakebite envenoming in western Maharashtra, India.

Ninety-one cases of snakebite were admitted between January 1998 and January 2001 to the general hospital at Mahad, 180 km south of Mumbai in western Maharashtra, India. Twenty-nine (31.9%) patients, when admitted to hospital, brought the snakes responsible for the bites (20 kraits, 9 Echis carinatus). Forty-five (49.5%) patients had snakebite without envenoming; 27 patients had local fang marks without local and systemic manifestations; 18, reporting 24 h after the bite, had local oedema. Twenty-six (28.6%) patients were paralyzed. Twenty-five cases who reported between midnight and 08:00 showed no local signs of envenoming. One patient, who reported at 16:00, had local oedema with blebs and a history of cobra bite. Ten (11.0%) patients died: 3 on the way to hospital and 7 during treatment. Out of 7 cases transferred for tertiary care, 6 recovered and 1 died on the way to Mumbai. Early administration of anti-snake venom (ASV), endotracheal intubation and timely intervention with manual ventilation by Ambu bag and anticholinesterase treatment for Elapidae (krait and cobra) envenoming are crucial for saving lives. Clinical confirmation of snakebite with envenoming was by identification of the dead snake brought by victims and by clinical signs and symptoms such as paralysis (krait and cobra) and rapid progressive local oedema with active bleeding (E. carinatus and Russell's viper). The 20-min whole blood clotting test is a simple, rapid and reliable test of coagulopathy. It is also of use in assessing the effectiveness of ASV and is of crucial importance for controlling administration of expensive ASV in relation to restoration of blood coagulability.