Anti-Snake Venom Protocol for Common Krait Bite
The recommended initial dose of Anti-Snake Venom (ASV) for a common krait bite is 10 vials, which should be administered immediately upon diagnosis to prevent respiratory failure from the primarily neurotoxic venom. 1
Initial Management
- Activate emergency medical services immediately for any person bitten by a common krait 2
- Rest and immobilize the bitten extremity to reduce systemic absorption of venom 2
- Remove rings and other constricting objects from the bitten extremity to prevent damage from swelling 2
- Apply a pressure immobilization bandage with pressure between 40-70 mm Hg in upper extremities and 55-70 mm Hg in lower extremities around the entire bitten limb to slow venom dissemination 2
Harmful Practices to Avoid
- Do not apply suction as it removes very little venom, has no clinical benefit, and may aggravate the injury 2
- Avoid applying ice to the snakebite wound as it may cause tissue injury 2
- Do not use electric shock as it is ineffective and potentially harmful 2
- Avoid applying tourniquets as they can worsen local tissue injury 2
Antivenom Administration Protocol
- Ensure airway management and ventilatory support if needed before antivenom administration 2
- Establish intravenous access for antivenom administration 2
- Administer 10 vials of polyvalent antivenom as the initial dose for common krait bite 1, 2
- Monitor closely for adverse reactions during ASV administration 1
Respiratory Support
- Common krait venom causes primarily neurotoxic effects leading to paralysis within minutes to hours 1
- Respiratory paralysis is common and requires immediate intervention 3
- Patients with evidence of respiratory insufficiency require rapid intubation and artificial ventilation 3
- Mechanical ventilation may be required for extended periods (8-30 hours or more) in severe cases 4
Additional Therapeutic Considerations
- Anticholinesterase drugs (like neostigmine) have shown inconsistent results in krait bites 4, 3
- Higher doses of neostigmine than normally recommended have been found ineffective in reversing neuroparalytic features 5
- Some patients may require very high doses of polyvalent ASV for reversal of neurological manifestations 6
- Continuous monitoring is essential as venom antigenaemia can recur even after initial clearance with antivenom 4
Special Considerations
- Common krait bites often occur while victims are sleeping, especially during monsoon season 5, 3
- Local signs at the bite site are often negligible or absent, making diagnosis challenging 4
- Systemic envenoming can include paralysis, muscle pain, tenderness, and abdominal pain 4
- Myoglobinemia may occur in some cases, suggesting rhabdomyolysis 4
Common Pitfalls
- Delaying transport to a medical facility to attempt ineffective first aid measures can be fatal 2
- Failing to recognize krait bites due to minimal local symptoms can delay critical treatment 4, 7
- Underestimating the need for respiratory support can lead to preventable mortality 3
- Assuming a single dose of antivenom is sufficient - continuous observation is needed as recurrent neurotoxicity may occur 6