A 20-year-old man sleeping outdoors wakes at 3 am with severe abdominal pain and vomiting. On arrival he has bilateral ptosis, external ophthalmoplegia, and neck weakness, but the bite site shows only a faint fang mark with no pain, swelling, or bleeding. The species responsible is most likely:

• A Common krait (Bungarus caeruleus) ✓
• B Saw-scaled viper (Echis carinatus)
• C Russell's viper (Daboia russelii)
• D Indian cobra (Naja naja)

Explanation

The common krait characteristically bites sleeping persons at night, the bite is often painless with negligible local findings, and early abdominal pain with descending neuromuscular paralysis is typical. Vipers would produce prominent local swelling and coagulopathy, while cobra bites usually cause significant local pain and tissue necrosis at the site. The absence of any local reaction despite severe neurotoxicity points to krait envenomation.

Reference: WHO Guidelines for the Management of Snakebites in South-East Asia, 2nd ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.