A Case of Envenomation by Bungarus Multicinctus

Abstract

In terms of the amount and toxicity of its venom, Bungarus multicinctus (B. multicinctus) places third on a list that includes six epidemiologically important venomous landsnakes in Taiwan. However, as a cause of mortality, B. multicinctus is at the top of the list. This is because the neurotoxic bungarotoxin can cause neuromuscular blockade of a victim’s respiratory muscles, resulting in rapid deterioration in the patient’s respiratory physiology which may lead to respiratory failure and death. In addition, the site of a snakebite by B. multicinctus often results in only a minimal local reaction, thus its importance may frequently be overlooked by both medical personnel and the patient, causing a delay in the golden hours of treatment. If emergency medical personnel have a clear understanding of the envenoming process and are able to give the appropriate antivenom and supportive respiratory care at the onset of ptosis or chest tightness, the mortality rate due to B. multicinctus can decrease dramatically. Herein we present a successful experience in managing a case of envenomation by B. multicinctus.