Here is an article I wrote about snakebite in Sri Lanka:

Snakebite is a serious public health problem in Sri Lanka, affecting thousands of people every year. According to the World Health Organization, Sri Lanka has one of the highest rates of snakebite mortality in the world, with an estimated 40,000 snakebites and 400 deaths annually1. The majority of snakebite victims are rural farmers and plantation workers, who are exposed to venomous snakes in their daily activities2.

The most medically important snakes in Sri Lanka are the Russell’s viper, the cobra, the Ceylon krait, the saw-scaled viper, and the hump-nosed pit viper. These snakes can cause severe envenoming, leading to complications such as bleeding, paralysis, kidney failure, and tissue necrosis3. The clinical manifestations and management of snakebite depend on the species of snake, the amount and composition of venom injected, the site and depth of the bite, and the time elapsed since the bite4.

The first and most important step in snakebite management is to identify the snake, if possible, and to assess the severity of envenoming. The snake identification can be done by observing the physical characteristics of the snake, such as its color, pattern, size, shape, and head. However, this can be challenging and unreliable, especially in cases of partial or obscured views, or when the snake has escaped or been killed. Therefore, it is advisable to use other methods of snake identification, such as the 20-minute whole blood clotting test (20WBCT), which can indicate the presence of procoagulant venom, or the use of a hotline service that can provide expert advice on snake identification and management.

The 20WBCT is a simple and inexpensive test that can be performed at the bedside or in the field. It involves collecting a small amount of blood from the patient and placing it in a clean glass tube. The tube is then left undisturbed for 20 minutes, and then tilted to see if the blood has clotted or not. A positive test (no clotting) indicates the presence of procoagulant venom, which can cause disseminated intravascular coagulation (DIC) and bleeding. A negative test (clotting) indicates the absence of procoagulant venom, but does not rule out the possibility of neurotoxic or cytotoxic venom.

The hotline service is a network of experts who can provide guidance on snake identification and management over the phone. The service is available 24 hours a day, and can be accessed by calling the numbers listed on the SLMA Snakebite Hotline page. The callers are advised to provide as much information as possible about the snake, the bite, and the patient, and to follow the instructions given by the hotline staff. The hotline service can also help with the identification of non-venomous or mildly venomous snakes, which can cause anxiety and panic among the victims and their relatives.

The mainstay of snakebite treatment is antivenom therapy, which involves the administration of specific antibodies that can neutralize the venom and prevent or reverse its effects. Antivenom therapy should be initiated as soon as possible after the bite, preferably within the first hour, and continued until the signs and symptoms of envenoming subside. The type and dose of antivenom depend on the species of snake, the severity of envenoming, and the availability of antivenom. In Sri Lanka, there are two types of antivenom available: Indian polyvalent antivenom (IPAV) and Sri Lankan monovalent antivenom (SLMAV). IPAV is effective against the venom of four major snakes: Russell’s viper, cobra, Ceylon krait, and saw-scaled viper. SLMAV is effective against the venom of the hump-nosed pit viper, which is not covered by IPAV.

Antivenom therapy is not without risks, as it can cause adverse reactions, such as anaphylaxis, serum sickness, or pyrogenic reactions. These reactions can be mild, moderate, or severe, and can occur immediately or delayed. The management of antivenom reactions involves the use of premedication, such as antihistamines, corticosteroids, and adrenaline, and the monitoring of vital signs, oxygen saturation, and urine output. The antivenom infusion should be stopped or slowed down if a reaction occurs, and resumed or increased if the reaction subsides. The antivenom reactions can be prevented or minimized by using the lowest effective dose of antivenom, diluting the antivenom in normal saline, and administering the antivenom slowly over at least one hour.

In addition to antivenom therapy, snakebite patients require supportive and symptomatic care, such as wound care, pain relief, fluid resuscitation, blood transfusion, ventilation, dialysis, and tetanus prophylaxis. The snakebite patients should be closely observed and monitored for at least 24 hours after the bite, and longer if there are signs of envenoming or antivenom reactions. The snakebite patients should also be referred to a tertiary care hospital if there are indications of severe envenoming or complications, such as respiratory failure, renal failure, or compartment syndrome.

Snakebite is a preventable and treatable condition, but it requires prompt and appropriate intervention to reduce the morbidity and mortality associated with it. The prevention of snakebite involves the avoidance of contact with snakes, the use of protective clothing and footwear, the use of snake repellents, and the education and awareness of the public and the health workers about the risk and management of snakebite. The treatment of snakebite involves the identification of the snake, the assessment of the envenoming, the administration of antivenom therapy, and the provision of supportive and symptomatic care. The improvement of snakebite management requires the availability and accessibility of antivenom, the training and supervision of health workers, the establishment and maintenance of a hotline service, and the collection and analysis of snakebite data.