Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 25 , ISSUE 6 ( June, 2021 ) > List of Articles

Pediatric Critical Care

Serious Adverse Reactions to Anti-snake Venom in Children with Snake Envenomation: An Underappreciated Contributor to Snakebite Mortality?

Rashmi Hooda

Citation Information : Hooda R. Serious Adverse Reactions to Anti-snake Venom in Children with Snake Envenomation: An Underappreciated Contributor to Snakebite Mortality?. Indian J Crit Care Med 2021; 25 (6):720-723.

DOI: 10.5005/jp-journals-10071-23836

License: CC BY-NC 4.0

Published Online: 01-06-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Background: Deaths due to snakebites and serious adverse reactions to anti-snake venom (ASV) are both underreported in India. Serious adverse reactions to ASV are common, contributing significantly to mortality and morbidity. We conducted a study to determine the frequency of occurrence of severe adverse reactions to ASV in children and study the various risk factors and their outcomes. Patients and methods: We carried out a retrospective record review of all children of snake envenomation admitted in our tertiary care teaching hospital, from January 2013 to December 2016. Children aged 0 to 12 years admitted for snake envenomation and who received ASV as part of their treatment were included. Details about their management, including ASV usage and any adverse effects noted, were collected on a standard data collection form. Results: Sixty-eight children were enrolled. Hemotoxic (52.9%) envenomation was more common than neurotoxic (35.2%). Severe adverse reactions were present in 42.6%, hypotension in 38.2%, and bronchospasm in 4.4% of the children. The overall mortality rate was 16.1%, anaphylaxis to ASV contributing to 36.3% of them. Mortality was significantly higher in cases with severe adverse reactions (p = 0.005). ASV reactions were also significantly different with different manufacturers. Conclusions: There is a high frequency of occurrence of severe adverse reactions to ASV resulting in significant morbidity and mortality.

  1. CBHI. National Health Profile. Central Bureau of Health Inteilligence – Ministry of Health and Family Welfare; 2015. p. 26–38.
  2. Chippaux, JP. (1998). Snake-bites : appraisal of the global situation / JP. Chippaux. Bull World Health Org 1998 ; 76(5) : 515-524
  3. Kasturiratne A, Wickremasinghe AR, De Silva N, Gunawardena NK, Pathmeswaran A, Premaratna R, et al. The global burden of snakebite: a literature analysis and modelling based on regional estimates of envenoming and deaths. PLoS Med 2008;5(11):e218. DOI: 10.1371/journal.pmed.0050218.
  4. Warrell DA. WHO/SEARO Guidelines for the clinical management of snake bites in the Southeast Asian region. Southeast Asian J Trop Med Public Health. 1999;30 Suppl 1:1-85. PMID: 10983553.
  5. Deshpande RP, Motghare VM, Padwal SL, Pore RR, Bhamare CG, Deshmukh VS, et al. Adverse drug reaction profile of anti-snake venom in a rural tertiary care teaching hospital. J Young Pharm 2013;5(2):41–45. DOI: 10.1016/j.jyp.2013.02.003.
  6. Accessed through:[12].pdf
  7. Adhisivam B, Mahadevan S. Snakebite envenomation in India: a rural medical emergency. Indian Pediatr. 2006 Jun;43(6):553-554. PMID: 16820669.
  8. Patil V, Patil H, Patil A, Agrawal V. Clinical profile and outcome of envenomous snake-bite at tertiary care centre in western Maharashtra. Int J Med Public Heal 2011;1(4):28–38. DOI: 10.5530/ijmedph.4.2011.7.
  9. Kumaravel KS, Ganesh J. A study on the clinical profile of children with snake envenomation in a tertiary referral centre at Dharmapuri, Tamil Nadu, India. Int J Res Med Sci 2016;4(6):2142–2145. DOI: 10.18203/2320-6012.ijrms20161775.
  10. Pore SM, Ramanand SJ, Patil PT, Gore AD, Pawar MP, Gaidhankar SL, et al. A retrospective study of use of polyvalent anti-snake venom and risk factors for mortality from snake bite in a tertiary care setting. Indian J Pharmacol 2015;47(3):270–274. DOI: 10.4103%2F0253-7613.157117.
  11. Amin M, Mamun S, Rashid R, Rahman M, Ghose A, Sharmin S, et al. Anti-snake venom: use and adverse reaction in a snake bite study clinic in Bangladesh. J Venom Anim Toxins Incl Trop Dis 2008;14(4):660–672. DOI: 10.1590/S1678-91992008000400009.
  12. Poovazhagi V, Ravikumar SA, Jagadeeshwari A, Arulganesh P, Raj PS, Anupama S. Anti-snake venom induced reactions among children with snake envenomation. Int J Contemp Pediatr 2017;4(2):629–634. DOI: 10.18203/2349-3291.ijcp20170722.
  13. Sankar J, Nabeel R, Sankar MJ, Priyambada L, Mahadevan S. Factors affecting outcome in children with snake envenomation: a prospective observational study. Arch Dis Child 2013;98(8):596–601. DOI: 10.1136/archdischild-2012-303025.
  14. Jayakrishnan MP, Geeta MG, Krishnakumar P, Rajesh TV, George B. Snake bite mortality in children: beyond bite to needle time. Arch Dis Child 2017;102(5):445–449. DOI: 10.1136/archdischild-2016-311142.
  15. Raghuraman MS, Sivaraman B. Comparative study of anaphylaxis incidence in patients receiving anti- snake venom with or without prophylactic adrenaline : a prospective, randomized, blinded study. Int J Basic Clin Pharmacol 2016;5(4):1436–1440. DOI: 10.18203/2319-2003.ijbcp20162449.
  16. Morais V, Massaldi H. Snake antivenoms: adverse reactions and production technology. J Venom Anim Toxins Incl Trop Dis 2009;15(1):2–18. DOI: 10.1590/S1678-91992009000100002.
  17. Sutherland SK. Antivenom use in Australia. Premedication, adverse reactions and the use of venom detection kits. Med J Aust. 1992 Dec 7-21;157(11-12):734-739. PMID: 1360618.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.