Anti-snake venom induced reactions among children with snake envenomation

Background: Snake envenomation in children is a neglected tropical condition with high morbidity and mortality. Life threatening neurotoxic and hemotoxic envenomation in children demands timely Anti Snake Venom (ASV) administration to improve the outcome.Methods: This was a prospective observational study undertaken at the pediatric intensive care unit of tertiary care referral center at Chengalpattu. All the 26 children with evidence of snake envenomation were recruited after informed consent of the caregivers during the study period. Clinical presentation and ASV related reactions were studied.Results: In this study of 26 children with envenomation, neurotoxic envenomation was more common. Foot was the common bite site. 10 of the 18 children (55.5%) had nocturnal bites. Ptosis, local swelling, hypotonia, headlag, vomiting and shock were the common clinical features. Polyvalent antivenom was used in all these children. ASV reactions of varying severity was encountered in 18 of the 26 children (69.2%). All the acute ASV reactions were encountered in the first 30 minutes. All the 18 children had rashes to begin with. Rashes and itching were the common feature of ASV reactions. Among children with reactions shock was seen in 50 %. Overall mortality was 3.85% (one child). None died due to anaphylaxis. The administration of ASV in primary and secondary centers was not carried out in time and the occurrence of anaphylaxis were not managed with inj adrenaline prior to referral. Inj pheniramine maleate, atropine and hydrocortisone were used by those centers. Referral after ASV reactions led to delay in completion of ASV administration.Conclusions: Occurence of ASV reactions is high in children (69%). There is an undue delay in ASV completion with ASV reactions. There is an urgent need for prevention of ASV reactions either by monovalent venoms or premedication prior to ASV administration.