Neostigmine for the Treatment of Neurotoxicity Following Envenomation by the Asiatic Cobra

Envenomation by the monocellate cobra (Naja kaouthia) is usually manifested clinically as neurotoxicity and local tissue necrosis. Treatment often requires administration of large quantities of antivenin, resulting in a high incidence of serum reactions. In cases where antivenin administration may be delayed for several hours or administration is contraindicated, the use of the anticholinesterase drug neostigmine may temporarily reverse the potentially lethal neurological effects of the venom. Detailed in this report is the case of immediate and dramatic reversal of envenomation symptoms following the administration of the anticholinesterase neostigmine methyl sulfate. [Gold BS: Neostigmine for the treatment of neurotoxicity following envenomation by the Asiatic cobra. Ann Emerg Med July 1996;28:87-89.]