King cobra (Ophiophagus hannah)

King cobra (Ophiophagus hannah) envenomations are rare in the United States and Great Britain. Recently (May 2, 2016), a North Carolina man (Ali Iyoob) suffered a king cobra bite on his wrist from a snake in his private collection. Instead of calling for assistance he elected to drive himself to a hospital. On the way, he stopped and called 911 to report that he had been bitten by a king cobra. An ambulance was dispatched to his location on the highway. Suffering from classical signs (nausea, blurry vision, perfuse perspiration, anxiety) of king cobra envenomation he was taken to University of North Carolina Hospitals for treatment. King cobra venom can also affect the nervous system causing pain, dizziness, paralysis and respiratory failure. A problem treating envenomation by exotic animals is that most hospitals do not routinely stock the appropriate antivenom. In ali lyoob’s case, a source of of antivenom was located at the Riverbank Zoo in Columbia, South Carolina. After a wait of several hours the antivenom arrived and lyoob was successfully treated. Treatment of snakebite by the appropriate antivenom is often dramatically successful. On the Facebook page of the Reptile Rescue of the Carolinas, lyoob has been described as “a biologist, respected reptile enthusiast and RROTC Liason…”

In an earlier envenomation at the sea aquarium in Myrtle Beach, South Carolina, a professional reptile handler suffered a king cobra bite on his right thumb at 10:15 AM. He drove himself to the regional medical center, arriving at 10:30 AM. Initial complaints included severe pain, nausea and swelling of the thumb. Subsequently, edema and erythema extending to the wrist ensued. The palm was especially involved. During the next 90 minutes neurological symptoms appeared, including bilateral ptosis, confusion, inability to swallow (dysphagia), slurred speech, generalized flaccidity and a decline in oxygen saturation. Because of respiratory paralysis, an endotracheal tube was inserted and mechanical ventilation was initiated. This occurred 2 hours after envenomation. Antivenom was administered starting at 2 PM and finishing at 4 PM. Seven hours after envenomation, the patient was alert and removed his endotracheal tube. The next morning most of the neurological symptoms were resolved and the patient left the hospital against medical advice.

In 2006 the first recorded envenomation by a king cobra was reported in Great Britain. A 22 year old man was bitten on his left index finger. Upon arrival at the British equivalent of an emergency room, the patient was lucid but complained of dizziness. Soon, eyelid ptosis developed as did other symptoms, including shortness of breath and the inability to swallow. The patient was then intubated and transferred to the intensive care unit where he displayed hypertension and an erratic pulse. King cobra specific antivenin was administered when it arrived. This was six hours after the bite occurred. Anaphylaxis is a possible complication due to snake antivenom administration. This occurred and was successfully treated and antivenom administration can continued at a slower rate. Seventeen hours after the bite symptoms began to resolve and the endotracheal tube was removed. Twenty-four hours after the bite, the patient was discharged from the intensive care unit and a plastic surgeon continued treatment for the ischemic damage done to his finger.

These envenomations are remarkable in that all were rapidly and successfully treated with king cobra specific antivenom. Without access to venom, death is a very reasonable probability due to respiratory paralysis. It is also worth noting that all of these envenomations occurred in males who were/are skilled in the handling of venomous snakes.

King cobra antivenom is made by the Thia Red Cross and the Central Research Institute in Kasauli, India. In the United States, king cobra antivenom is available from the Miami-Dade Fire Rescue Venom Response Unit (Emergency telephone number: 786-336-6600). Presumably, zoos that maintain king cobras in their herpetological collections also possess stocks of king cobra antivenom.

References and links

North Carolina Man bitten by Pet King Cobra