title: Naja Kaouthia: two cases of Asiatic cobra envenomations.
abstract: Envenomation from cobra bites causes major morbidity and mortality in Asia and Africa but rarely in the United States. We describe two patients bitten by the Asiatic Cobra (Naja Kaouthia)--both successfully treated in the emergency department. Patient 1 was a 23-year-old woman bitten in the buttock by her cobra. Examination demonstrated two puncture wounds. She developed cranial neuropathy, respiratory failure, and coagulopathy 10 h later, necessitating endotracheal intubation and polyvalent antivenom administration. The patient recovered fully with minimal wound necrosis. Patient 2, a 44-year-old man, was bitten on the hand by his cobra. Examination revealed a puncture wound with progressive swelling. Edrophonium and monovalent antivenom were administered, and he recovered uneventfully. These cases emphasize the varied clinical presentations of the Asiatic cobra. Patient 1 developed delayed neurotoxicity, respiratory failure, and hematotoxicity with minimal wound necrosis, whereas Patient 2 experienced a more typical clinical course.
authors.affiliation: Department of Emergency Medicine, University of Pittsburgh Medical Center, Presbyterian Hospital, Pittsburgh, Pennsylvania 15213, USA.
authors.forename: Gautam
authors.initials: G
authors.lastname: Khandelwal
authors.forename: Kenneth D
authors.initials: KD
authors.lastname: Katz
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Brooks
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Gonzalez
authors.forename: Colleen D
authors.initials: CD
authors.lastname: Ulishney
mesh_terms: D000328:Adult; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use*; D004546:Elapid Venoms / Q000009:adverse effects*; D017815:Elapidae; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D009336:Necrosis / Q000209:etiology; D020258:Neurotoxicity Syndromes / Q000503:physiopathology* / Q000628:therapy; D012909:Snake Bites / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology
chemical_list: D000997:Antivenins; D004546:Elapid Venoms