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.
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