title: Neuromuscular transmission failure due to common krait (Bungarus caeruleus) envenomation.
abstract: 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.
authors.affiliation: Department of Medicine, Dayanand Medical College, Ludhiana 141001, Punjab, India.
authors.forename: G
authors.initials: G
authors.lastname: Singh
authors.forename: H S
authors.initials: HS
authors.lastname: Pannu
authors.forename: P S
authors.initials: PS
authors.lastname: Chawla
authors.forename: S
authors.initials: S
authors.lastname: Malhotra
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D000931:Antidotes / Q000627:therapeutic use; D000997:Antivenins / Q000627:therapeutic use; D017838:Bungarus; D002648:Child; D004491:Edrophonium / Q000627:therapeutic use; D004558:Electric Stimulation; D004576:Electromyography; D005260:Female; D006801:Humans; D008297:Male; D009046:Motor Neurons / Q000502:physiology; D018482:Muscle, Skeletal / Q000294:innervation / Q000502:physiology; D009431:Neural Conduction / Q000502:physiology; D009468:Neuromuscular Diseases / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology*; D009475:Neurons, Afferent / Q000502:physiology; D012909:Snake Bites / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D009435:Synaptic Transmission / Q000502:physiology*
chemical_list: D000931:Antidotes; D000997:Antivenins; D004491:Edrophonium