Evaluation of myotoxicity and neuropathy in hemotoxic snake bite envenomation in a tertiary care center

Background: Snakebite is a significant health problem in India, particularly in rural areas. Hemotoxic snakebites can cause myotoxicity, leading to acute kidney injury and other complications due to extensive muscle injury. This study aimed to investigate the clinical severity of myotoxicity in hemotoxic snakebite patients and its effect on AKI. Methods: A prospective observational study was conducted among 50 patients with hemotoxic snakebite admitted to a tertiary care center in Odisha. Clinical manifestations, serum creatine phosphokinase levels and nerve conduction studies were evaluated. Results: The majority of patients were males (74%) in the 30-39 age group. Russell's viper was the most common species responsible for envenoming (60%). Elevated serum CPK levels were found in 80% of patients, indicating muscle damage. Local necrosis was associated with significantly higher mean CPK levels (555.78±353.51 U/l). AKI was observed in 46% of patients, with serum creatinine levels correlating with AKI severity. Nerve conduction studies revealed abnormalities in two-thirds of cases, including axonal neuropathy and motor-sensory deficits. Conclusions: Myotoxicity is a significant complication of hemotoxic snakebite, contributing to AKI and other systemic manifestations. Serum CPK levels may serve as a useful biomarker for predicting tissue damage severity. Early identification, continuous monitoring and supportive care are crucial in managing snakebite victims. Further research is needed to validate these findings and refine the use of serum CPK in clinical decision-making.