Snake Bite

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mohammed sediq

Health & Medicine Education

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INTRODUCTION: Kerosene is a low viscosity flammable liquid. Three types of kerosene mainly available in the market: Commercial Kerosene ( Colourless) PDS (Public Demand Supply – Blue dyed) Aircraft fuel Kerosene is known to cause harm to various body organs and systems. Poisoning is usually due to ingestion either accidentally (in children) or with suicidal intent (in adults) and sometimes due to inhalation of fumes. Kerosene poisoning is a very uncommon mode of poisoning. EXPOSURE AND TOXICOKINETICS : MECHANISM OF TOXICITY : Toxicity is: Due to exposure of un-combusted row kerosene. Due to fuel performance additives. Due to its exhaust emission Kerosene is a mixture of n-alkane, branched alkanes, alkyl mono-aromatics, diaromatics, naphthalene, and polynuclear aromatics. CLINICAL SYMPTOMS: Respiratory effects: Acute respiratory infect, Lung cancer, Pulmonary tuberculosis, and Asthma. Cardiac effects: Cardiac arrhythmia and Ventricular fibrillation. Dermal effects: Dermal irritation, sensitization, skin lesions, and dermatitis. Ocular effects: Mild irritation to eye induced to hyperaemic conjunctivitis and lacrimation. TREATMENT: In the case of acute exposures, the first step is to remove the patient from exposure. In the case of ingestion of kerosene, Gastric lavage should not be undertaken. Broad-Spectrum antibiotics like amoxicillin should be given through intravenously. In the case of pulmonary pneumonitis, cefuroxime should be given through intravenously and oral. Ceftriaxone is also included in the treatment system in combination with cefuroxime. In the case of ocular exposure, immediately moisten the affected eye carefully with water and 0.9% saline. HISTOPATHOLOGICAL AND POSTMORTEM EXAMINATION: Histopathological examination of colonic biopsy revealed chronic discontinuous granulomatous inflammation of the colon. On PM examination acute gastroenteritis and kerosene odor may be observed on the opening chest and abdominal cavity. In the stomach, petechial hemorrhages with congested mucosa are found. Degenerative changes in liver and kidneys and hypoplasia of bone marrow are the significant symptoms. In case of suspected death from kerosene viscera preserved in saturated saline for chemical analysis. ANALYSIS: Kerosene in biological material is isolated by steam distillation. The distillate should be collected in the ice-cold condition in a 20ml saturated solution of NaCl. The top layer (1 cm.) of the distillate is taken out after some time and extracted four times with a 10ml portion of diethyl ether. The combined ethereal extract is dried by passing through a hydrous sodium sulfate, evaporated at room temperature and subjected to analyze in a UV spectrophotometer. On scanning in the e UV spectrophotometer, maxima are observed at 223 – 228 µm. A small amount of extract is also used to examine in headspace GC-MS and compare with standard peaks. (for kerosene ≈270nm).

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Dr. Sachin Verma is a young, diligent and dynamic physician. He did his graduation from IGMC Shimla and MD in Internal Medicine from GSVM Medical College Kanpur. Then he did his Fellowship in Intensive Care Medicine (FICM) from Apollo Hospital Delhi. He has done fellowship in infectious diseases by Infectious Disease Society of America (IDSA). He has also done FCCS course and is certified Advance Cardiac Life support (ACLS) and Basic Life Support (BLS) provider by American Heart Association. He has also done a course in Cardiology by American College of Cardiology and a course in Diabetology by International Diabetes Centre. He specializes in the management of Infections, Multiorgan Dysfunctions and Critically ill patients and has many publications and presentations in various national conferences under his belt. He is currently working in NABH Approved Ivy super-specialty Hospital Mohali as Consultant Intensivists and Physician.

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Envenomation is the process by which venom is injected by the bite or sting of a venomous animal such as a snake, scorpion, spider, or insect. Arthropods can infest human skin ex: head lice. Arthropods can inflict bites and stings. They can carry diseases such as malaria, yellow fever and filariasis. Order of insects belongs to stings are: a) Hymenoptera - bees, wasps, hornets, fire ants. b)Scorpionida- scorpions. Hymenoptera venom contains Biogenic amines (histamine, 5-HT and acetylcholine), enzymes (phospholipase A and hyaluronidase) toxic peptides (kinins in wasps, mast cell degranulating peptides in bees). Clinical features & Treatment 1) Local reaction: Clinical features Local pain Edema Airway obstruction By wasps - severe cutaneous infection & cellulitis (serious bacterial infection, skin is swollen and inflamed) Treatment: Remove stings Local application – 20% Aluminium sulfate Antihistamines – Diphenhydramine (500mg), Chlorpheniramine (4mg) 2) Allergic reaction – Tingling sensation, flushing, vomiting, Urticarial skin rash, pedal edema. Sometimes fever, malaise, renal failure. Treatment: 0.1% adrenaline Antihistamins, Corticosteroids Cardiac monitoring, Analgesics, Haemodialysis- for renal failure. Toxic reaction: Multiple stings vasodilation, Hypotension, Fatigue, Diarrhoea, Headache seizures, Delayed toxic reaction: Renal failure, coagulopathy. Treatment : Parenteral antihistamins. Large dose corticosteroids. Bronchodilators Haemo dialysis. Vit k for coagulopathy SCORPION: Scorpions differ in colour from straw yellow or light brown, to black. Tail of the scorpion terminates into Bulbous enlargement called telson, which contains the stinger and venom apparatus. venom The main toxins include phospholipase, acetylcholinesterase, hyaluronidase, serotonin, and neurotoxins. The venom of Buthus species of India contains phospholipase A, which causes gastrointestinal and pulmonary haemorrhages, and disseminated intravascular coagulation ( presence of severe abnormal blood clots in blood vessel) Mode of Action Affects Na+ channels with prolongation of Action Potentials. Depolarisation of Nerves of both Adenergic & PSNS Clinical features: Local: Rapidly developing local pain, swelling, edema, lymadenopathy. Systemic: Autonomic stimulation, Mydriasis, Profuse sweating, Excessive salivation Urticaria, Hypertension, Convulsions, Priapism, nausea, Pulmonary oedema may develop within 2 to 3 hours leading to death, Intracerebral haemorrhage, TREATMENT: 1) During transport to hospital: Immobilize the affected extremity. Do NOT apply tourniquet. Local application of ice is beneficial in relieving pain. Prolonged cryotherapy is however contraindicated. A negative-pressure suction device may be used, if available 2)On Arrival at Hospital: Rep. failure- Mechanical Ventilation, administer oxygen. Pain- PCM/Morphine tabs. Allergy- Antihistamines. Nifidepine 10 to 20 mg (adults) prazocin HCL, Dopamine, Diazepam, Metoclopramide, Antivenom therapy

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