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Bungarus multicinctus
General Details, Taxonomy and Biology, Venom, Clinical Effects, Treatment, First Aid , Antivenoms
Bungarus multicinctus ( Chinese Krait )  [ Original photo copyright © Dr Julian White ]
Family: Elapidae
Subfamily: Elapinae
Genus: Bungarus
Species: multicinctus
Subspecies: multicinctus , wanghaotingii
Common Names
Chinese Krait , Many Banded Krait , Silver Banded Krait , Taiwan Krait
Local Names
Yin Huan She , Ho-suwah-tsat
Region
Southeast Asia + North Asia
Countries
China, Hong Kong, Laos, Myanmar, Taiwan, Thailand
 
Taxonomy and Biology
Adult Length: 1.20 m
General Shape
Medium in length, slender, triangular in cross-section bodied snake with a short tail. Can grow to a maximum of about 1.85 metres ( B. m. multicinctus ) or 1.25 metres ( B. m. wanghaotingii ). Head is flat and slightly distinct from neck. Eyes are small in size and black with a barely visible round pupils. Nostrils are large. Dorsal scales are smooth and glossy with the vertebral row slightly enlarged. Dorsal scale count 15 - 15 - 15.
Habitat
Elevations up to about 1300 metres in a wide range of habitats ( bamboo forest, coastal rainforest, dry to moist subtropical forest ) but most common in lowland plains and hilly regions in subtropical to moist open forest terrain.
Habits
Nocturnal and terrestrial snake. Tends to hide under stones or in holes during the day. Never found too far from water. Inoffensive distribution. When disturbed it coils loosely and hides its head beneath its body. Reluctant to bite except upon persistent provocation.
Prey
Feeds mainly on snakes, but will occasionally feed on eels, fish and frogs.
Species Map
Small (Approx 20k) version
 
Venom
Average Venom Qty
11 mg ( dry weight ), Sawai (1976) ( Ref : R000769 ).

4.6 mg ( dry weight ), Gopalakrishnakone and Chou (1990) ( Ref : R000004 ).
General: Venom Neurotoxins
Pre- & Post-synaptic neurotoxins
General: Venom Myotoxins
Not present
General: Venom Procoagulants
Not present
General: Venom Anticoagulants
Not present
General: Venom Haemorrhagins
Not present
General: Venom Nephrotoxins
Not present
General: Venom Cardiotoxins
Not present
General: Venom Necrotoxins
Not present
General: Venom Other
Not present or not significant
 
Clinical Effects
General: Dangerousness
Severe envenoming likely, high lethality potential
General: Rate of Envenoming: Unknown but likely to be high
General: Untreated Lethality Rate: 20-30%
General: Local Effects
None or minimal
General: Local Necrosis
Not likely to occur
General: General Systemic Effects
Variable non-specific effects which may include headache, nausea, vomiting, abdominal pain, diarrhoea, dizziness, collapse or convulsions
General: Neurotoxic Paralysis
Very common, flaccid paralysis is major clinical effect
General: Myotoxicity
Not likely to occur
General: Coagulopathy & Haemorrhages
Unlikely to occur
General: Renal Damage
Unlikely to occur
General: Cardiotoxicity
Unlikely to occur
General: Other
Not likely to occur
 
First Aid
Description: First aid for bites by Elapid snakes which do not cause significant injury at the bite site (see Comments for partial listing), but which may have the potential to cause significant general (systemic) effects, such as paralysis, muscle damage, or bleeding.
Details
1. After ensuring the patient and onlookers have moved out of range of further strikes by the snake, the bitten person should be reassured and persuaded to lie down and remain still. Many will be terrified, fearing sudden death and, in this mood, they may behave irrationally or even hysterically. The basis for reassurance is the fact that many venomous bites do not result in envenoming, the relatively slow progression to severe envenoming (hours following elapid bites, days following viper bites) and the effectiveness of modern medical treatment.
2. The bite wound should not be tampered with in any way. Wiping it once with a damp cloth to remove surface venom is unlikely to do much harm (or good) but the wound must not be massaged. For Australian snakes only, do not wash or clean the wound in any way, as this may interfere with later venom detection once in a hospital.
3. All rings or other jewellery on the bitten limb, especially on fingers, should be removed, as they may act as tourniquets if oedema develops.
4. If the bite is on a limb, a broad bandage (even torn strips of clothing or pantyhose) should be applied over the bitten area at moderate pressure (as for a sprain; not so tight circulation is impaired), then extended to cover as much of the bitten limb as possible, including fingers or toes, going over the top of clothing rather than risking excessive limb movement by removing clothing. The bitten limb should then be immobilised as effectively as possible using an extemporised splint or sling.
5. If there is any impairment of vital functions, such as problems with respiration, airway, circulation, heart function, these must be supported as a priority. In particular, for bites causing flaccid paralysis, including respiratory paralysis, both airway and respiration may be impaired, requiring urgent and prolonged treatment, which may include the mouth to mask (mouth to mouth) technique of expired air transfer. Seek urgent medical attention.
6. Do not use Tourniquets, cut, suck or scarify the wound or apply chemicals or electric shock.
7. Avoid peroral intake, absolutely no alcohol. No sedatives outside hospital. If there will be considerable delay before reaching medical aid, measured in several hours to days, then give clear fluids by mouth to prevent dehydration.
8. If the offending snake has been killed it should be brought with the patient for identification (only relevant in areas where there are more than one naturally occurring venomous snake species), but be careful to avoid touching the head, as even a dead snake can envenom. No attempt should be made to pursue the snake into the undergrowth as this will risk further bites.
9. The snakebite victim should be transported as quickly and as passively as possible to the nearest place where they can be seen by a medically-trained person (health station, dispensary, clinic or hospital). The bitten limb must not be exercised as muscular contraction will promote systemic absorption of venom. If no motor vehicle or boat is available, the patient can be carried on a stretcher or hurdle, on the pillion or crossbar of a bicycle or on someone's back.
10. Most traditional, and many of the more recently fashionable, first aid measures are useless and potentially dangerous. These include local cauterization, incision, excision, amputation, suction by mouth, vacuum pump or syringe, combined incision and suction ("venom-ex" apparatus), injection or instillation of compounds such as potassium permanganate, phenol (carbolic soap) and trypsin, application of electric shocks or ice (cryotherapy), use of traditional herbal, folk and other remedies including the ingestion of emetic plant products and parts of the snake, multiple incisions, tattooing and so on.
 
Treatment
Treatment Summary
Krait bites can cause moderate to severe flaccid paralysis, respiratory failure, requiring intubation & ventilation in severe cases. Antivenom available for major species, may prevent worsening of paralysis, but may not reverse established paralysis.
Key Diagnostic Features
Minimal to mild local reaction + flaccid paralysis
General Approach to Management
All cases should be treated as urgent & potentially lethal. Rapid assessment & commencement of treatment including appropriate antivenom (if indicated & available) is mandatory. Admit all cases.
Antivenom Therapy
Only antivenoms available are for related species, but should be used for significant envenoming
Antivenoms
1. Antivenom Code: SAsSIC02
Antivenom Name: Purified Bungarus multicinctus Antivenom
Manufacturer: Shanghai Institute of Biological Products
Phone: ++86-21-6280-3189
Address: No. 1262, Yan An Rd. (W)
Shanghai
200052
Country: Peoples Republic of China
2. Antivenom Code: SAsVCT01
Antivenom Name: Bivalent Antivenom Elapid, Naja-Bungarus antivenin
Manufacturer: National Institute of Preventative Medicine
Phone: +886-2-2395-9825
Address: Linshen Office Address:
No.6, Linshen S. Rd., Taipei, Taiwan 100,
R.O.C.

Kunyang Office Address:
No.161, KunYang St., Taipei, Taiwan 115,
R.O.C.
Country: Taiwan
Bungarus multicinctus ( Chinese Krait ) [ Original photo copyright © Dr Julian White ]
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