DOI: http://dx.doi.org/10.18203/2349-3933.ijam20180404

Study of clinical profile and outcome of acute kidney injury in acute poisoning and envenomation

Siva Kumar D. K., Karthikeyan M.

Abstract


Background: Envenomation and poisonings can cause renal damage by number of mechanisms. Some of them may cause rhabdomyolysis or hemolysis, thereby leading pigment induced renal injury. Other contributory factors like shock, sepsis can also cause acute kidney injury (AKI). The study was done with the aim to evaluate the clinical profile and outcome of acute kidney injury in acute poisoning and envenomation and to find the relationship between early anti serum venom (ASV) administration and early presentation to tertiary care and outcome.

Methods: This prospective observational study carried out on 50 patients with history of envenomation and poisoning after meeting the requirements of inclusion criteria. History, examination findings and investigations results were collected and analysed.

Results: The incidence of AKI in envenomation and poisoning patients was 5.62%. Majority of the toxin induced AKI were due to the poisoning constitutes about 62%. Among them, paraquat (n=15) was the most common poison. snake bites were the commonest to cause AKI in the envenomation group (n=17). The average time between the event and arrival to hospital was 31 hours. Whereas in case of died patients, the average time between the event and arrival to hospital was about 59 hours. The mean time interval between poison consumption to ASV administration in recovered cases was 6.6 hours and in death cases it was 15 hours. Dialysis requirement was in about 43 (86%) patients. Of them 37 patients underwent hemodialysis (HD). 6 patients underwent peritoneal dialysis (PD). Total number of deaths in the study was 26 and the most common cause was respiratory failure (38.5%).

Conclusion: The present study suggests the most common cause of AKI in case of envenomation was snake bite and in case of toxin it was paraquat poisoning. Hence it is necessary to take initiative by the government to increase the facilities in primary health care centers to save the lives of the affected people and to impose restrictions on the availability of poisonous substances in the market. 


Keywords


Acute kidney injury, Snake venom, Chemical poisoning

Full Text:

PDF

References


Mohapatra B, Warrell DA, Suraweera W, Bhatia P, Dhingra N, Jotkar RM, et al. Million Death Study Collaborators. Snakebite mortality in India: a nationally representative mortality survey. PLoS Negl Trop Dis. 2011;5(4):e1018.

Rachaiah NM, Jayappagowda LA, Siddabyrappa HB, Bharath VK. Unusual case of acute renal failure following multiple wasp stings. N Am J Med Sci. 2012;4:104–6.

Deshpande PR, Ahsan Farooq KK, Bairy M, Prabhu RA. Acute renal failure and/or rhabdomyolysis due to multiple bee stings: A retrospective study. N Am J Med Sci. 2013;5:235–9.

Naqvi R. Acute kidney injury from different poisonous substances. World J Nephrol. 2017;6(3):162-7.

Smal KK, Sahu HK, Kar MK, Palit SK, Kar BC, Sahu CS. Yellow oleander (cerbera thevetia) poisoning with jaundice and renal failure. J Assoc Physicians India. 1989;37:232–3.

Chugh KS. Snake-bite-induced acute renal failure in India. Kidney Int. 1989;35:891–907.

Pinho FM, Zanetta DM, Burdmann EA. Acute renal failure after Crotalus durissus snakebite: a prospective survey on 100 patients. Kidney Int. 2005;67:659–67.

Warrel DA. World Health Organisation; WHO Library Cataloguing-in-Publication data (NLM classification: WD 410). Guidelines for the management of snake-bites. 2010: 1–150.

Vikrant S, Jaryal A, Parashar A. Clinicopathological spectrum of snake bite-induced acute kidney injury from India. World J Nephrol. 2017;6(3):150-61.

Kalantri S, Singh A, Joshi R, Malamba S, Ho C, Ezoua J, et al. Clinical predictors of in-hospital mortality in patients with snake bite: A retrospective study from a rural hospital in central India. Trop Med Int Health. 2006;11:22–30.

Dharod MV, Patil TB, Deshpande AS, Gulhane RV, Patil MB, Bansod YV. Clinical predictors of acute kidney injury following snake bite envenomation. N Am J Med Sci. 2013;5:594–9.

Chugh KS, Pal Y, Chakravarty RN, Datta BN, Mehta R, Sakhuja V, Mandal AK, Sommers SC. Acute renal failure following poisonous snakebite. Am J Kidney Dis. 1984;4:30–8.

Cavalli RD, Fletcher K. An effective treatment for paraquat poisoning. In: Biochemical mechanisms of paraquat toxicity. Author AP, editor. New York: Academic Press; 1977: 213-234.

Singh S, Bambery P, Chaudhry D, Makharia G, Kakkar N, Singh D. Fatal paraquat poisoning: report of two cases. J Assoc Phys Ind. 1999;47(8):831-2.

Banupriya M, Mahendrakumar K, Karthik PS, Kannan R. A study on clinical profile of paraquat poisoning in a tertiary care hospital. Int J Adv Med. 2017;4:1088-91.

Jegan A. Study of clinical profile and outcome of AKI in acute poisoning and envenomation. Ddissertation submitted to Madras Medical College, Tamil Nadu, India. 2014: 1-60.

Ramulu P, Rao PA, Swaroop KK, Marx PK, Devi CVR. A prospective study on clinical profile and incidence of acute kidney injury due to hair dye poisoning. Int J Res Med Sci. 2016;4:5277-82.

Zafar R, Munawar K, Nasrullah A, Haq S, Ghazanfar H, Sheikh AB, Khan AY. Acute Renal Failure due to Organophosphate Poisoning: A Case Report. Cureus. 2017;9(7):e1523.

Tadokoro M, Ozono Y, Hara K, Taguchi T, Harada T, Ideguchi M, Senju M. A case of acute renal failure due to ethylene glycol intoxication. Nihon Jinzo Gakkai Shi. 1995;37(6):353-6.

Chan YC, Fung HT, Lee CK, Tsui SH, Ngan HK, Sy MY, et al. A prospective epidemiological study of acute poisoning in Hong Kong. Hong Kong J Emerg Med. 2005;12:156–61.

Kumar SV, Venkateswarlu B, Sasikala M, Kumar GV. A study on poisoning cases in a tertiary care hospital. J Nat Sci Biol Med. 2010;1:35–9.