Five-year experience with Chinese cobra (Naja atra)--related injuries in two acute hospitals in Hong Kong.

OBJECTIVE: To review the clinical features and management of patients with injuries related to the Chinese cobra (Naja atra). DESIGN: Retrospective study. SETTING: Two acute hospitals in Hong Kong. MAIN OUTCOME MEASURES: The nature of injuries, envenoming features, complications, response to antivenom therapy, and outcome. RESULTS: Eighteen patients were recruited during the 5-year study period. Fifteen of them were snake-bitten, the remaining three suffered ocular injuries. Of the 15 patients with cobra bites, 14 (93%) presented with local swelling. No patient developed severe neurotoxic symptoms. Two patients had laboratory features of haemolysis. Fourteen patients received antivenom therapy and five of them subsequently underwent surgical interventions for extensive local tissue damage and necrosis. There was no fatality. CONCLUSION: Bites from Chinese cobra result in serious local complications with extensive tissue necrosis and minimal neurotoxic symptoms. There is an apparent trend of favourable outcomes following the early administration of antivenom to patients without early signs of irreversible tissue damage. Further research is needed to evaluate the effectiveness of early antivenom use in Chinese cobra bites in order to minimise extent of tissue damage.