Krait found in the Shoes

This was a news item from Times of India 27 June 08 , Chennai edition.

Karthikeyan, a resident of Selvavinayagar Koil Street in West Mogappair, Chennai had a brush with death on Wednesday night when he reached out to pick up a shoe in his house. To his shock, he found a snake popping its head out. He called up the Velachery animal rescue and rehabilitation centre which rushed its personnel to the house. What they recovered was a 3.5-feet-long female adult krait (Bungarus fasciatus), the most poisonous land snake found in India.

Let us look at more detail about the Krait, the most venomous snake of the Indian Subcontinent:

Common name in Tamil - Kattu viriyan, Yennai viriyan, Yettadi viriyan.

Behavior
All kraits are nocturnal. The snake is more docile during the daylight hours, becoming more aggressive during the night. However, they are rather timid and will often hide their heads within their coiled bodies for protection.

Venom
Bungarus species contain neurotoxic venom that is 16 times more potent than cobra venom. Krait venom is extremely powerful and quickly induces muscle paralysis. Clinically, their venom contains mostly pre-synaptic neurotoxins. These affect the ability of nerve endings to properly release the chemical that sends the message to the next nerve. Following envenomation with bungarotoxins, transmitter release is initially blocked (leading to a brief paralysis), followed by a period of massive overexcitation (cramps, tremors, spasms), which finally tails off to paralysis. Not all these phases may be seen in all parts of the body at the same time.
Note that there is frequently little or no pain at the site of a krait bite and this can provide false reassurance to the victim. Typically, victims start to complain later of severe abdominal cramps accompanied by progressive muscular paralysis, frequently starting with ptosis. As there are no local symptoms, a patient should be carefully observed for tell-tale signs of paralysis (eg the onset of ptosis, diplopia and dysphagia) and treated urgently with antivenom. Before antivenom was developed, there was an 85% mortality rate among bite victims.

Treatment:
Once at a healthcare facility such support should be provided until the venom is metabolised and the victim can breathe unaided especially if there is no species-specific antivenom available. Given that the toxins alter acetylcholine transmission which causes the paralysis, some patients have been successfully treated with cholinesterase inhibitors such as physostigmine or neostigmine, but success is variable and may be species dependent as well. If death occurs it typically takes place approximately 6 to 12 hours after the krait bite, but can be significantly delayed. Cause of death is often respiratory failure ie suffocation via complete paralysis of the diaphragm. Even if patients make it to a hospital subsequent permanent coma and even brain death from hypoxia may occur given potentially long transport times to get medical care.

Historical fact:
In 2001, herpetologist Dr. Joe Slowinski was bitten by a juvenile krait (B. multicinctus) while doing field research in Myanmar. He was unable to reach medical assistance and subsequently died from the effects of the bite.