Bites by the Philippine cobra (Naja naja philippinensis): prominent neurotoxicity with minimal local signs.

We studied 39 patients envenomed by the Philippine cobra (Naja naja philippinensis). Neurotoxicity occurred in 38 cases and was the predominant clinical feature. Respiratory paralysis developed in 19 patients, and was often rapid in onset--in 3 cases apnea occurred within 30 min of the bite. There were 2 deaths, both in patients who were moribund upon arrival at the hospital. Three patients developed necrosis, and 14 individuals with systemic symptoms had no local swelling. Both cardiotoxicity and reliable nonspecific signs of envenoming were absent. Bites by the Philippine cobra produce a distinctive clinical picture characterized by severe neurotoxicity of rapid onset and minimal local tissue damage.