High mortality due to poisonous snakebite is a formidable health hazard. It is a matter of concern for health care providers especially in agrarian countries of South East Asian region. (Mohapatra et al., 2011; Halesha et al., 2013; Chugh et al., 1983; Chugh, 1989; Mukhopadhyay et al., 2010a) Cases of snakebite envenomation comprise medical emergency. The outcome of therapy however, depends on how fast and prompt medical care is initiated. It also depends on how specific antidotes are administered and monitored clinically.
Given the socio-cultural scenario of developing countries, treatment is often delayed due to several inter related issues. Ignorance, superstition, lack of infrastructure and inadequate logistic support are some of the factors that contribute to the high mortality in the vulnerable population.
Clinically snakebite envenomation can be broadly classified into neurotoxic and vasculotoxic. Cobra and krait both belong to the neurotoxic variety while viper bites are vasculotoxic. Other organ involvement like myotoxicity and cadiotoxicity has also been reported in snakebite.
The composition of KRAIT (Bungarus faciatus) venom is essentially neurotoxic. Symptoms develop very rapidly and most often the bites are painless and marks are invisible in the body. Earlier works have reported significant clinical and autopsy changes in the Krait bite fatalities.
The venom of the banded krait (Bungarus faciatus) mainly contains neurotoxins (pre- and postsynaptic neurotoxins).These include acetylcholine (Ach) esterase, phospholipase B, and glycerophosphatase. Common Indian krait venom contains both presynaptic beta bungarotoxin and alpha bungarotoxin (Bawaskar & Bawaskar, 2015). LD50 values of 2.4 mg/kg—3.6 mg/k SC, 1.289 mg/kg IV and 1.55 mg/kg IP are reported. The average quantity of venom delivered per bite is 20–114 mg. Engelmann and Obst (1981) listed the venom yield at 114 mg (dry weight). (Engelmann, 1982).
The major clinical effects caused by the venom of this species include vomiting, abdominal pain, diarrhoea, and dizziness. Severe envenomation leads to rapid respiratory failure and death. A hospital based study revealed maximum mortality and severity in krait (60%) followed by cobra (13.33%) and viper (8.9%) envenomation (Saravu et al., 2012).
Another investigation by clinical toxicologists reported untreated mortality rate of 1—10%,. This may be because contact with humans is rare .the amount of injected venom in defensive bites is lower than aggressive ones. A polyvalent antivenom is currently available and widely used in India and several other south Asian countries. Regional variation in clinical presentation has been described in bite by some species of Cobra (Robed Amin et al., 2014; Chippaux et al., 1991).
Report from Thailand, Malaysia and Bangladesh showed rapid death due to Krait bite.Renal involvement in snake bite has been reported and discussed at length in earlier works (Chugh, 1989; Mukhopadhyay et al., 2010a; Bawaskar & Bawaskar, 2015; Engelmann, 1982; Robed Amin et al., 2014; Chippaux et al., 1991).