Clinical Case Reports on Black Krait (Bungarus niger/lividus) Neurotoxic Snakebites in Assam, Northeast India.

The greater black krait (Bungarus niger) and the lesser black krait (Bungarus lividus), venomous snakes of the Elapidae family, pose a significant health risk in Assam, Northeast India. However, their clinical effects remain underreported. A retrospective analysis was performed on 10 cases of envenomation attributed to B. niger/B. lividus. The patients were admitted to a rural health center and two adjacent hospitals in Assam. The victims exhibited severe neurotoxic symptoms, including ptosis, quadriplegia, respiratory muscle weakness, dysphonia, dysphagia, myalgia, and a gradual generalized neuromuscular weakening culminating in respiratory paralysis. The subjects were administered standard commercial polyvalent antivenom (PAV) targeting the "big four" snakes of India along with calcium gluconate (20 mg/kg). Standard antivenom was ineffective in reversing the established neuromuscular blockade; however, early administration of PAV before venom-induced damage to the presynaptic granules was linked to accelerated recovery in certain patients. Supportive care, including elective endotracheal intubation and assisted ventilation, was critical for recovery.