American Journal of Medical Sciences and Medicine
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American Journal of Medical Sciences and Medicine. 2020, 8(4), 144-148
DOI: 10.12691/ajmsm-8-4-1
Open AccessArticle

Predictive Value of Bedside Clotting Time in Determining the Volume of Antivenom in Patients Bitten by Snake

David Olorunfemi Samuel1, , Obiomah Abimbola Yewande2 and Adetutu Olawale Joseph2

1Department of Internal Medicine, College of Health Sciences, Bingham Univeristy Teaching Hospital, Jos, Plateau State, Nigeria

2Department of Family Medicine, Bingham University Teaching Hospital, Jos, Plateau State, Nigeria

Pub. Date: August 19, 2020

Cite this paper:
David Olorunfemi Samuel, Obiomah Abimbola Yewande and Adetutu Olawale Joseph. Predictive Value of Bedside Clotting Time in Determining the Volume of Antivenom in Patients Bitten by Snake. American Journal of Medical Sciences and Medicine. 2020; 8(4):144-148. doi: 10.12691/ajmsm-8-4-1

Abstract

Snake bite is a common problem in Nigeria and indeed in many parts of the world. [1] There seems to be a seasonal variation in the cases of snake bites that are reported. Although snake bite can happen anytime of the year, most reports are noted at the beginning of and during the period of rain. [2,3,4] This is when there is a significant change in the weather and the arrival of rain which fills the holes hence driving the snakes out and also for them to tap sun energy. During this time as well, farmers begin the usual farming season and hence increase in the risk of coming into contacts with several reptiles and rodents among which that with snakes has been noted to be the most dangerous of such encounters. [3] Snake bite can be fatal sometimes despite adequate attention but over the years there has been a decline in the mortality in some places due to prompt initiation of antivenom and other therapeutic measures including analgesics, antibiotics and tetanus toxoid. [2,5,6,7] However, it is of interest to note that it is not all such bites that are from snakes, it is not all bites from venomous snakes that results in envenomation needing the use of antivenom and by all means it is not all snakes that are venomous. [5] Antivenoms has been used from 20mls to 80mls to neutralise envenomation, there is paucity of data indicating the specific amount to be used in any condition of snake bites. [4,7,8] Dosages has been guided by the local and systemic indications for their usage and this may be confusing in rural areas. [8] More so that we have to use the same dosage regardless of the age of the patient since the amount of the venom injected into the host is the same considering the volume of distribution in children and adult or obese and the severely wasted individual. [7] Antivenoms whether monovalent or polyvalent are not entirely safe and sometimes anaphylaxis may happen despite adequate precaution. [6,8] Against this background, we tried to find a relationship between the clotting time done by the bedside and the volume of antivenom required by the patient. We tried to see if it could be possible to use the clotting time to predict the exact amount of the antivenom that will be required in cases of snake bite requiring envenomation. This we hoped may prevent the irregularity in the dosage of the antivenom and help standardize the use of antivenom in every hospital.

Keywords:
clotting time snake bites antivenom

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References:

[1]  Habib AG. Public health aspects of snakebite care in West Africa: perspectives from Nigeria. Journal of venomous animals and toxins including tropical diseases. 2013;19(1):27.
 
[2]  Williams D, Gutiérrez JM, Harrison R, Warrell DA, White J, Winkel KD, Gopalakrishnakone P. The Global Snake Bite Initiative: an antidote for snake bite. The lancet. 2010; 375(9708): 89-91.
 
[3]  Akani GC, Ebere N, Franco D, Eniang EA, Petrozzi F, Politano E, Luiselli L. Correlation between annual activity patterns of venomous snakes and rural people in the Niger Delta, southern Nigeria. Journal of Venomous Animals and Toxins including Tropical Diseases. 2013; 19(1): 2.
 
[4]  Habib AG, Abubakar SB. Factors affecting snakebite mortality in north-eastern Nigeria. International Health. 2011; 3(1): 50-5.
 
[5]  Gold BS, Dart RC, Barish RA. Bites of venomous snakes. New England Journal of Medicine. 2002; 347(5): 347-56.
 
[6]  Abubakar IS, Abubakar SB, Habib AG, Nasidi A, Durfa N, Yusuf PO, Larnyang S, Garnvwa J, Sokomba E, Salako L, Theakston RD. Randomised controlled double-blind non-inferiority trial of two antivenoms for saw-scaled or carpet viper (Echis ocellatus) envenoming in Nigeria. PLoS neglected tropical diseases. 2010; 4(7): e767.
 
[7]  Abubakar SB, Abubakar IS, Habib AG, Nasidi A, Durfa N, Yusuf PO, Larnyang S, Garnvwa J, Sokomba E, Salako L, Laing GD. Pre-clinical and preliminary dose-finding and safety studies to identify candidate antivenoms for treatment of envenoming by saw-scaled or carpet vipers (Echis ocellatus) in northern Nigeria. Toxicon. 2010; 55(4): 719-23.
 
[8]  Warrell DA. Snake bite. The Lancet. 2010; 375(9708): 77-88.
 
[9]  Aghahowa SE, Ogbevoen R N. Incidence of snake bite and utilization of antivenom in the University of Benin Teaching Hospital Benin City, Nigeria. Niger J Exp Clin Biosci 2017; 5: 5-10.
 
[10]  Eric K. I. Omogbai†, Zuleikha A. M. Nworgu, Michael A. Imhafidon, Anwakang A. Ikpeme, David O. Ojo and Charles N. Nwako. Snake bites in Nigeria: A study of the prevalence and treatment in Benin City. Tropical Journal of Pharmaceutical Research, Vol. 1, No. 1, June, 2002 pp. 39-44.