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Most snake venom myotoxins are based on phospholipase A2 and cause systemic myolysis of skeletal muscle, rarely affecting cardiac or smooth muscle. The damage occurs to individual muscle cells, sparing the basement membrane, thus regeneration of muscle usually occurs, commencing about 3 days post-bite and is complete after about 28 days. Experimentally, only slow-twitch fibres regenerate, but this is unconfirmed yet in human cases. In the process of muscle destruction, there is massive release of myoglobin, creatine kinase and potassium. The former is associated with secondary renal damage and often gross myoglobinuria. Theoretically, antivenom therapy should have no effect if muscle breakdown is already established, but experience in Australia suggests even late antivenom treatment may reduce the severity of muscle damage. Myotoxins are found in both Elapid and Viperid species.

Snakes known to have systemic myotoxins of medical significance.

Scientific name Common name Effect
Micropechis ikaheka New Guinea small eyed snake Moderate systemic myolysis
Micrurus spp. (selected) Selected Sth American coral snakes Moderate systemic myolysis
Notechis spp. Australian tiger snakes Severe systemic myolysis
Oxyuranus spp. Australian taipans Moderate systemic myolysis
Pseudechis spp. Australian mulga & black snakes Moderate to severe systemic myolysis
Tropidechis carinatus Rough scaled snake Severe systemic myolysis
  Various Sea snakes Moderate to severe systemic myolysis
Bothrops spp. (selected) Selected species of South American pit vipers Moderate systemic myolysis
Crotalus spp. (selected) Selected species of South American rattlesnakes Moderate systemic myolysis
Daboia russelii pulchella Sri Lankan Russell’s viper Moderate systemic myolysis


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