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Abstract
Common krait (Bungarus caeruleus) is the deadliest snake found commonly in the dry
zone of Sri Lanka. In Anuradhapura, 210 farmers bitten by the common krait over a
three year period were investigated prospectively from 1 January 1996. The sex ratio
was equal, 110 (52%) patients were in the age group 10-30 years. One hundred and one
(48%) patients were severely envenomed and needed mechanical ventilation from 12 hours
to 29 days (mode two days). The bite occurred at night while the victims were asleep
on the floor. In 99 (47%) situations killed specimens were available for identification.
The cardinal symptom was abdominal pain developing within hours of the bite. Alteration
in the level of consciousness was observed in 150 (71%) patients: drowsy in 91 (43%),
semiconscious in 24 (11%), and deep coma in 35 (17%). Autonomic disturbances included
transient hypertension, tachycardia, lacrimation, sweating, and salivation. These
manifested in 139 (66%) patients with moderate to severe envenomation. One hundred
and forty nine (71%) had hypokalaemia and 105 (50%) metabolic acidosis, anterograde
memory loss in 84 (40%), and delayed neuropathy in 38 (22%) patients. Polyvalent antivenom
had no significant benefit (t = 0.5) in reversing respiratory paralysis and preventing
delayed neurological complications. Sixteen (7.6%) patients died and a submucosal
haemorrhage in the stomach was seen at necropsy in three cases. Mortality could be
minimised with early and free access to mechanical ventilation.