BACKGROUND

Snake envenomation accounts for 91 deaths in the Philippines (Roberts et. al., 2021). The management of snakebite envenomation poses a critical challenge, particularly in settings with limited antivenom supplies. This study determines the symptom severity of snakebite envenomation and treatment outcomes of snakebite patients admitted in Northern Mindanao Medical Center from October 2017 to October 2022, who received lower doses of cobra antivenom with or without Neostigmine.

METHODS

This was a single center descriptive study that reviewed 82 medical records of admitted snakebite patients at NMMC. Data were analyzed using descriptive statistics.

RESULTS

Admitted snakebite patients came from Bukidnon (42%), Misamis Oriental, Cagayan de Oro City, Lanao del Norte, Lanao del Sur, and Misamis Occidental. Those affected were predominantly 19-59 years old (mean age of 33), mostly male (73%), living in rural areas, and working in agriculture. At least half of the patients (45%) with signs of neurologic envenoming received less than the standard protocol dose of Cobra antivenom. The rest received Neostigmine (1%), both Cobra antivenom and Neostigmine (11%), and neither (43%). Moderate envenomation predominated (46%), followed by mild (43%) and severe (11%) envenomation. Regardless of symptom severity, most patients received 1-2 ampules (28 patients) or 3-5 ampules (14 patients); only four `patients received 6-10 ampules. Moderate and severe envenomation could be managed with reduced antivenom. Patients stayed in the hospital for 3-6 days (55%). The majority were discharged improved (96%). No mortality was noted. Only four patients experienced adverse effects from Cobra antivenom (skin rash and dyspnea) and Neostigmine (skin rash). 

CONCLUSION

Most cases occurred in the rural province of Bukidnon, primarily affecting males aged 19-59 (mean age 33) working in agriculture. Moderate and severe envenomation were effectively managed, fully reversing envenomation symptoms with reduced antivenom doses (1-5 ampoules), contrary to established guidelines recommending higher doses. The use of Neostigmine as an adjunct therapy appears promising for addressing antivenom supply shortages. Majority were discharged improved and a low incidence of adverse reactions. 

Human ; Animals ; Snake Bites ; Snake Envenomation ; Neostigmine

BACKGROUND

Caustic ingestion is a major public health problem worldwide [1]. It imposes huge economic burden in terms of medical cost to poorly resourced health system of developing countries [2]. Household cleaning products, such as sodium hypochlorite (NaOCI), are the most common cause of caustic exposure [3]. NaOCI ingestion consistently ranks second in caustic ingestion cases in Northern Mindanao Medical Center (NMMC) based on toxicology census from 2015 to 2018. The aim of this study is to determine the epidemiologic profile, clinical findings and outcome of admitted patients who ingested NaOCI.

METHODS

This a single-center descriptive, cross-sectional study of 40 cases of sodium hypochlorite ingestion admitted at NMMC from January 2015 to December 2018.

RESULTS

There were a total of 17 males and 23 females. Majority of patients were 0-5 years of age (46.5%; mean age of 2), followed by age range of 18-64 years old (40.0%; mean age of 35). Twenty-nine cases (72. 5%) cases of NaOCI ingestion were accidental and the remaining 11 (27.5%) were non-accidental. The non-accidental cases belong to the 12-17 (mean age 15.3) and 18-64 (mean age 31) years old age groups at 33.3% and 66.7%, respectively, with prevalence in females at 81.8%. Non-accidental cases increase with age, and among females. Majority of all ingested less than 50 ml of NaOCI. Two non-accidental cases (18.2%) ingested more than 100 ml of NaOCI were observed to have more than 2 signs and symptoms. Majority of patients presented with vomiting. Greater portion of non- accidental cases complained of abdominal or epigastric pain (54.5% vs 10%), oropharyngeal erythema (9.1 % vs 6.9), and odynophagia (45.5% vs 0). None of the patients had serious signs and symptoms. All patients were discharged improved and without sequelae.

CONCLUSION

Most NaOCI cases were accidental especially in children. Non-accidental cases increase significantly with age, with most cases found among adolescents and young adults, with higher prevalence among females. Majority of patients only ingested less than 50 ml, and that ingestion of 100 ml or more of NaOCI is associated with more than 2 signs and symptoms. The most predominant symptom is vomiting. Greater portion of non-accidental cases complained of abdominal or epigastric pain and odynophagia. None of the patients exhibit severe signs and symptoms. This study showed that all 40 cases of sodium hypochlorite ingestion did not have sequelae upon discharge.

Human ; Sodium Hypochlorite