Snake bites in childhood and treatment principles

Snake envenomation is a reason of serious mortality and morbidity in trophical zones. Because of the hot climate of Southeastern Anatolia region, snake envenomation is seen oftenly. This study include 108 child were bitten by poisonous snake that admitted and hospitalized Resarch Hospital of Dicle University Pediatric department between October 2006 and May 2011 retrospectively. Patients in the study are evaluated to localization of bite, time and season bite, symptoms, clinical signs, laboratory findings, first treatment time and option, toxic effects and complications, spesific treatment options and tetanus immunization. The patients ages who admitted to research hospital of Dicle University pediatric department ranges between 2-15 years and average age was 10.21±3.08 years. 72 of patients were male (66.7%), 36 of patients were female (33.3%). These 108 case were investigated retrospectively. 60 of our cases (55.6%) in Diyarbakir, 17 (15.7%) of Mardin, 13 (12%) were admitted to Şırnak and 73 (67.6%) lived in rural areas of these provinces. Most of bites were seen between the months of May-June. 27 cases (25%)were bited in May, 20 (18.5%) were bited in June and 19 (17.6%) were bited in July. The time to reach the nearest health institution in our cases was unknown after the bittting and the average time for admission to hospital was 5.1±8.06 hours. Especially the lower extremities (69.4%) were frequently bitten. Most poisonings in 57 (52.8%) with the number of cases has been between the hours of 12:00 to 18:00. 10 (9.3%) of our cases which admitted to our unit (9.3%) tourniquet was applied proximal to the bite area. Bleeding was applied to 9 (8.4%) cases. Suction was applied to 3(2.8%) cases. İce was not applied any of our cases. In our patients, local signs which often seen at presentation were varying degree of pain, erythema and edema at same extremity. 47 patients (43.5%) were admitted with grade 2, 31 (28.7%) were admitted with grade 3. Most frequent complication developed during treatment was the compartment syndrome (9.2%). In 3 cases came from other center, fasciotomy was opened due to compartment syndrome. 7 of our cases were consulting with orthopedics and fasciotomy was opened because of compartment syndrome. All subjects received oral or intravenous fluid therapy. Because of tetanus vaccination in rural areas in our region not apply regularly, 84 of our cases who cauld not get vaccination Schedule were received to tetanous toksoid. Antibiotics were used in 89 cases (82.4%), analgesia were used in 93 cases (86.1%), corticosteroids were used in 63 cases (58.3%), antihistaminic were used in 62 cases (57.4%) and antivenom were used in 86 cases (74.07%). Any minor adverse reactions to antivenom serum occurred in our unit. One of our patient died. She was 4 years old and she has got severe anemia, DIC and respiratory failure. In ıntensive care unit, she was entubated and followed 7 days with mechanical ventilation support. In one case whom developed necrosis of the second finger of right hand was performed amputation."