Asia Pacific Journal of Medical Toxicology

Analysis of fourteen cases of snake bite envenomation admitted in ICU of a tertiary care hospital of Bangladesh : A retrospective observational study

Document Type : Original Article

Authors

AKM Ferdous Rahman 1
Mohammad Salim 1
Saifullah Al Kafi 2
Abu Saleh 2
MD Mamunur Rashid 2
Tania Tanzil Eva 2
Imrana Ali 2
Mohammad Omar Faruq 3

1 Department of Critical Care Medicine, Dhaka Medical College Hospital, Bangladesh

2 Critical Care Medicine MD Resident (Phase B), Department of Anesthesia, Pain, Palliative & Intensive Care, Dhaka Medical College Hospital. Bangladesh

3 Professor and Chief consultant CCM & EM, United Hospital, Dhaka, Bangladesh

https://doi.org/10.22038/apjmt.2025.86619.1503
Abstract
 Background: Effective management strategies for snake envenomation are critical for reducing the morbidity and mortality as treatment gaps, delays, and reliance on traditional healers frequently exacerbate outcomes. This study provides insights into the clinical presentation, management, and outcomes of snakebite envenomation in Bangladesh admitted at an ICU, highlighting key risk factors for mortality and potential interventions.
Methods: This retrospective observational study reviewed data from 14 patients admitted to the intensive care unit (ICU) at Dhaka Medical College Hospital, Bangladesh between January 2023 and July 2024. Variables including demographic details, snakebite characteristics, baseline clinical parameters and patient outcomes were assessed.
Results: The study found snakebite envenomation predominantly affecting  males (92.8%) and urban residents (78.5%). Russell’s viper was responsible for 57.15% of bites followed by cobras and kraits. 42.85% victims consulted traditional healers initially. Cellulitis and gangrene were noted in   57.14% and   7.14% respectively. Neurotoxic effects (50%) included ptosis and respiratory paralysis. Acute kidney injury and ventilator associated pneumonia occurred in 57.14% and 42.85% of cases respectively. Treatment involved polyvalent antivenom, blood transfusions (78.5%), mechanical ventilation (64.29%), and hemodialysis (50%). In-hospital mortality was 35.71%, with an average ICU stay of 4.72 days. Hemodialysis significantly reduced the odds of mortality.
Conclusion: Acute kidney injury and ventilator-associated pneumonia are critical complications driving mortality risk.  Timely hemodialysis is a vital life-saving intervention in severe envenomation cases.  Enhanced public awareness, rapid referral systems and accessible critical care facilities are very much important to reduce snakebite-associated mortality in Bangladesh.
 

Keywords

Snake bite
Snake bite envenomation
Snake bite mortality
Russell's viper
Subjects
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Asia Pacific Journal of Medical Toxicology
Volume 14, Issue 3
Summer 2025
Pages 102-108

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