Clinical presentation, outcome and management of snakebite cases in Saudi Arabia

Background: Snakebite envenomation remains a significant public health concern in Asir Province of Saudi Arabia. Aim: To characterize snake species and the clinical presentation, outcome and management of snakebite cases admitted to 4 major hospitals in Asir Province, Saudi Arabia . Methods: This retrospective study reviewed medical records of paediatric and adult snakebite cases admitted to 4 regional hospitals in Saudi Arabia between January 2000 and December 2021 using search terms "snakebite", "cobra", "polyvalent antivenin", "antivenom", "compartment syndrome", and "fasciotomy". The data were analysed using R software version 4.2. Results: Sixty-nine patients were identified, of whom 30 (43.5%) were children aged <18 years. Severe local or systemic manifestations occurred in 33 patients (47.8%) while compartment syndrome was suspected in 14 patients (20.3%), requiring fasciotomy in 11 (15.9%). The systemic manifestations included neurotoxicity (13 patients; 18.8%), coagulopathy (31 patients; 44.9%), rhabdomyolysis with creatine phosphokinase >1000 U/L (8 patients; 11.6%), and acute kidney injury (4 patients; 5.8%), with 2 progressing to end-stage renal disease. Three patients (4.5%) died. A majority (94%) received initial 5-vial antivenom dose, with 39% requiring additional doses. Antivenom-related adverse reactions were mild and transient in 6 patients (9%). Blood products and antibiotics were used in 30% and 67% of cases, respectively. Anticholinesterase therapy was administered to 3 patients (4.3%). Conclusion: Snakebites pose a significant public health threat in Asir Province of Saudi Arabia. Antivenom, in addition to supportive care, remains the cornerstone of therapy, however, to optimize patient outcomes, our study highlights the need for a more comprehensive approach to management, as well as vigilant monitoring with prompt recognition and interventions.