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Five patients were bitten by the Malayan krait Bungarus candidus (Linnaeus) in eastern Thailand or north western Malaya. Two patients were not envenomed but the other three developed generalised paralysis which progressed to respiratory paralysis in two cases, one of which ended fatally. One patient showed parasympathetic abnormalities. Anticholinesterase produced a dramatic improvement in one patient. Another patient probably benefited from paraspecific antivenom.The efficacy of antivenoms and adjuvants such as anticholinesterases in patients with neurotoxic envenoming requires further study.he was breathless and unable to open his mouth or swallow. Doses of 20 ml non-specific antivenom, 8 mg dexamethasone, and 0-5 mg atropine were given intravenously. At four hours he could not breathe and was intubated and ventilated manually.On admission to Pra Pokklao Hospital, Chantaburi, seven and a half hours after the bite the patient was fully conscious but almost completely paralysed and had bilateral ptosis. He replied to questions by flexing fingers and toes. When manual ventilation was stopped briefly he became distressed, sweaty, and cyanosed. The site of the bite was slightly tender but not swollen and showed the imprint of fangs and teeth. The pulse was 120/min and regular and blood pressure 140/70 mm Hg. The abdomen was moderately tender. There was flaccid tetraparesis with total bilateral external ophthalmoplegia, pronounced ptosis, inability to open the mouth, protrude the tongue, or swallow, and no gag reflex (table). Tendon and abdominal reflexes

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