Life-threatening hyponatremia after krait bite envenoming - a new syndrome

Bites by kraits are a major cause of snake bite death in South Asia, mainly because of their venom is paralytic causing respiratory failure. We describe another life-threatening effect of the venom of some Bungarus species.

We report the death of a young woman due to severe hyponatremia-induced brain damage after envenoming attributed to a Bungarus multicinctus. Her serum sodium of 137 mmol/l on admission dropped to 104 mmol/l within 48 h. The patient suddenly deteriorated with seizures and coma and showed signs of severe cerebral edema. The osmolality and sodium concentration in her urine were high. She died 18 days after the bite.

Since this case, a retrospective study and a prospective trial have confirmed the high risk of hyponatremia after envenoming by B. multicinctus. In addition, a recent study in southern Vietnam has shown that envenoming by the Malayan krait (Bungarus candidus) also commonly causes profound hyponatremia.

Hyponatremia is a potential serious complication in patients envenomed by B. multicinctus or B. candidus, and appropriate monitoring and management is necessary.