Cobra-bites

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Abstract
The clinical features following 47 proved cobra bites received in north-west Malaysia are summarized. More than half the patients had negligible or no poisoning-a most important prognostic and therapeutic fact. Absence of local swelling one hour or more after the bite is a valuable clinical indication that no venom has been injected. Neurotoxic effects in human subjects are rare, occurring in only 6 (13%) of the 47 victims. The most common feature of poisoning is local necrosis, which can be very extensive without any systemic envenoming. Specific antivenom does not prevent or ameliorate local necrosis. Specific antivenom should be given only after systemic poisoning becomes clinically evident as shown by objective paresis and apathy, with or without hypotension. The minimum effective antivenom dose is 100 ml and the intravenous route is mandatory.