Case history 01

 Date of admission: 04 - 08- 2021

A 45 year old lady presented to OPD with cheif complaints of snake bite 7 days back.

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic one week back. Then around 7:30 pm on Wednesday,patient was alleged to be bitten by snake( Russell viper) on right foot and taken to local hospital for treatment in 1hr and ASV was administered.

She was fine for one day. Then  she complains of swelling on right lower limb and went to local hospital for which ointment was advised.

Eventually, the swelling subsided. After 3days,  patients present with a 2-3 bilious vomiting with severe abdominal pain.

Abdominal pain is sqeezing type in preumbilical region.

There is no history of necrotic tissue changes around the bite.

No H/0 photophobia, phonophobia, lacrimation and diplopia

No H/0 of chest pain,  palpitation and syncopal attack

No H/0 of shortness of breath, orthopnea and PND

No H/0 burning micturition

No H /0 of pedal edema and facial paralysis.

PAST MEDICAL HISTORY:

Not a known case of HTN, CAD, asthma, TB, epilepsy, thyroid disorders.

No history of surgeries and blood transfusion in the past.

FAMILY HISTORY:

There is no history of similar complaints in the family. There is no history of cancer or sudden death in the family.

PERSONAL HISTORY:

Diet: mixed

Apetite: normal

Sleep : adequate

Bowel : constipation 

Micturition : normal

Addictions: no 

Menarche : 13 yrs

Normal menstrual cycle with normal flow

She is married with 4 children

TREATMENT HISTORY

Patient had not undergone any treatment prior. She is not allergic to any known drug.

GENERAL EXAMINATION:

Patient is conscious, cooperative, coherent and well oriented to time  place anf person.

There is no signs of icterus, clubbing, cyanosis and generalized lympadenopathy.

There is no pedal and bipedal edema.

 VITALS:

Temperature : afebrile

 Bp: 150/90

Pulse rate : 96bpm

Respiratory rate: 24/min

Spo2: 99% at room temperature

GRBS: 180mg %

 SYSTEMIC EXAMINATION:

CARDIOVASCULAR SYSTEM:

Chest wall is bilaterally symmetrical.

No precordial bulge

No visible pulsation, engorged veins, scars and sinuses

AUSCULTATION: S1 and S2 sounds are heard

RESPIRATORY SYSTEM:

Postion of trachea - central

Bilateral air entry- positive

Normal vesicular breath sounds heard

No added sounds

PER ABDOMEN:

Abdomen is distended, soft and non tender.

Bowel sounds heard

No palpable mass or free fluid

CENTRAL NERVOUS SYSTEM:

Patient is conscious

Speech - Normal

No signs of meningeal irritation

Motor and sensory system - normal

Reflexes- present

Cranial nerves- intact

INVESTIGATIONS:

PROVISIONAL DIAGNOSIS:

This is a case of acute kidney injury secondary to acute tubular necrosis secondary to snake bite with thrombocytopenia.

TREATMENT:

1. Foley's catherization for output monitoring

2. Oral fluids 3lites/ day

3.injection lasix 40mg / BD

4. Strict I/0 monitoring

5. Inj PAN iv/ OD

6. Inj zoffer 4mg/ iv

7. Inj Buscopan IM/ BD

TYPES OF SNAKES AND ITS COMPLICATIONS WITH CLINICAL FEATURES:

1. COBRA, SEA SNAKES, MAMBAS: neurotoxic-

C/f: hypotension, shock, other organ dysfunction( renal impairement)

2 VIPERS- Haemotoxic

C/f: progressive swelling., hypovolemic shock, development of blisters and bruises.

3. NAJA - extensive tissue injury and nervous injury

CAUSE OF  SYSTEMIC COMPLICATIONS:

venom alters capillary membrane permeability  causing extravasationof electrolytes, red blood cells and albumin through the vessel wall into the envenomated site. This process occurs in the lungs, kidney, myocardium, pericardium rarely CNS.

MECHANISM OF VIPER TO CAUSE TUBULAR BLOCKADE:

The damage to tubular cells of kidneys caused by lack of blood flow and oxygen which results in ischemia. 

It may occur if the kidney cells are damaged by a poison or harmful substances.

This condition results in Acute tubular necrosis which can lead to Acute kidney injury.

TECHNIQUES FOR REMOVAL OF VENOM FROM THE BODY:

1. first aid

2. Administration of antisnake venom

3. Mechanical ventilation if necessary