Clinico-epidemiological features of snakebite: a study from Eastern Nepal.

We studied 604 suspected snakebite cases seen at the peripheral snakebite treatment centre, Damak, Eastern Nepal from January to December 2000 using pre-designed proforma. Seventy-five per cent of the patients were in the age group 11-40 years. The common victims were farmers (44.2%) and housewives (31.7%). The bite was commonly encountered during farming (29.4%), working in the field (16.2%), walking (13.7%) and feeding cattle (9.2%). Sixty-five per cent were bitten during outdoor and agriculture related activities. Bite during sleep was recorded in 7%: 62% had sustained bite in lower limb. Forty-two per cent of the victims arrived at the treatment centre within 2 hours of being bitten. Fourteen patients arrived 7 hours after being bitten and six were dead on arrival. A common local practice (seen in 56.7%) was to eat chillies to confirm envenomation. Application of a tourniquet, often multiple, was the common (90%) first aid measure. Neurotoxicity was present in 11% (n=66) of the victims. Five had local features of envenomation. No case of coagulopathy was recorded. Reaction to anti-snake venom was noticed in 28.16% (n=20). Two patients died during treatment. Mortality among patients with features of neurotoxicity was 3%.