Neuromuscular transmission failure due to common krait (Bungarus caeruleus) envenomation

Muscle Nerve. 1999 Dec;22(12):1637-43. doi: 10.1002/(sici)1097-4598(199912)22:12<1637::aid-mus4>;2-a.


Neurophysiological studies were performed in 12 patients with neuromuscular paralysis due to envenomation by the common krait (Bungarus caeruleus). All patients presented with an acute, reversible, oculofaciobulbar paresis. In addition, 7 patients had weakness of the limb muscles and 4 required assisted mechanical ventilation. Neurophysiological abnormalities included: (1) a reduction in the amplitude of the median-elicited compound muscle action potential (CMAP) in 4 patients; and (2) a decremental response (>10%) to 3-Hz repetitive nerve stimulation (RNS) in 4 patients. With 1 exception, these abnormalities were noted only in clinically weak muscles. The administration of edrophonium to 6 patients produced an insignificant increase in CMAP amplitudes as well as partial (not significant) improvement in the decremental response to 3-Hz RNS. Neurophysiological studies were performed in 2 patients before and after the administration of 20 mL of polyvalent antivenom. A decrease in amplitude of the median-elicited CMAP amplitude occurred after the administration of antivenom. In 1 patient, administered 100 mL of antivenom, the median-elicited CMAP amplitude increased and the decrement to 3-Hz RNS decreased. Neurophysiological studies can provide useful information regarding the nature, severity, and therapy of the neuroparalytic syndrome of krait envenomation.

Publication types

  • Clinical Trial

MeSH terms

  • Adolescent
  • Adult
  • Animals
  • Antidotes / therapeutic use
  • Antivenins / therapeutic use
  • Bungarus*
  • Child
  • Edrophonium / therapeutic use
  • Electric Stimulation
  • Electromyography
  • Female
  • Humans
  • Male
  • Motor Neurons / physiology
  • Muscle, Skeletal / innervation
  • Muscle, Skeletal / physiology
  • Neural Conduction / physiology
  • Neuromuscular Diseases / drug therapy
  • Neuromuscular Diseases / etiology
  • Neuromuscular Diseases / physiopathology*
  • Neurons, Afferent / physiology
  • Snake Bites / complications
  • Snake Bites / drug therapy
  • Snake Bites / physiopathology*
  • Synaptic Transmission / physiology*


  • Antidotes
  • Antivenins
  • Edrophonium