Clinical manifestations of Cape cobra (Naja nivea) bites. A report of 2 cases

Two cases of proven bites by the Cape cobra (Naja nivea) are reported. Both patients developed areflexic flaccid paralysis and required ventilation from 2 1/4 and 2 1/2 hours after the bite for 4 1/2 and 7 days respectively. Antivenom is of value before the onset of paralysis but of no value once paralysis is established. Both patients developed a non-depolarizing neuromuscular block which was little affected by prostigmine. Early treatment in identified Cape cobra bites should be the immediate application of an arterial tourniquet, followed by intravenous administration of 80-100 ml polyvalent antivenom if signs of neurotoxicity develop. This may need to be repeated. Treatment once paralysis is established is largely supportive, prolonged ventilation frequently being required, following which recovery should be complete.