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The common krait (Bungarus caeruleus , Schneider 1801) is a proteroglyphous elapid snake commonly found in Sri Lanka, Pakistan, Bangladesh, and India. 1- 3 The highest incidence of bites in Sri Lanka was reported from the North Central Province, where the vegetation and climate provide an ideal habitat for snakes. 4- 6 Common victims of B caeruleus are farmers who live in open wattle-and-daub houses and farmers sleeping in watch huts in agricultural fields. 6- 8 A significant number of patients die before reaching hospital. 6, 9 The approximate incidence of common krait bite in the late 1970s was 8.6% in Sri Lanka; the remainder were bitten by the hump nosed viper (27%), Russell's viper (17.5%), and cobra (12%). 10 Surveys carried out in 1983 in the Anuradhapura district have shown that B caeruleus bites accounted for 45% of 110 deaths in the field due to snake bites. 9 However in recent years more patients have sought the life saving benefits of hospital treatment and the case fatality has come down significantly with assisted ventilation. 7, 8, 11 The counterpart, the Ceylon krait (Bungarus ceylonicus , Gunther 1864) is the indigenous species found upcountry and in the wet zone of Sri Lanka, but seldom bites man. 1, 12 Historically, both species are reputed to be the most poisonous snakes in the island. 1, 13
The aim of the study was to describe the epidemiology, define clinical features, study acute complications, delayed manifestations and outcome, analyse the efficacy of polyvalent antisera, study the pathophysiology, and define optimum intensive care management of common krait envenoming.
METHODS
The prospective study included all the admissions with common krait bite to the General Hospital, Anuradhapura, Sri Lanka, from 1 January 1996 to the end of 1998. This institution is the main referral centre situated in the central dry zone of the island and has facilities for assisted ventilation and intensive care. The offending snakes were identified by either studying characteristics of the dead snake if it was produced, or showing the patient specimens of formalin preserved snakes. If both failed, clinical features and circumstantial evidences were used for arriving at the diagnosis of common krait bite. Patients were assessed at the time of admission and periodically, until the...