A 55-year-old farmer presented to the emergency treatment unit with double vision and difficulty in speech.In addition to neurotoxicity, the medical literature associate's cobra bites with cardiac toxicity as well.When you want to activate a certain muscle, the motor neuron releases a neurotransmitter called acetylcholine, which in turn binds to nicotinic receptors on muscle surface.Unfortunately, neurotoxins released by the Cobra are identical to acetylcholine, but it doesn't produce muscle contraction when it binds with a nicotinic receptor.The key features I noticed were petasos or drooping of the eyelids and drooling of saliva, which shows difficulty in swallowing.The indications for administration of anti-venom are having local effects, involving more than half the length of a limb, or the presence of systemic signs like neurotoxicity.The neurotoxins released from the Kobra fangs were paralyzing his respiratory muscles.Since he couldn't take adequate breaths, the body was trying to compensate by increasing the respiratory rate.Swallowing difficulty and speech dysfunctions will appear when the toxicity involves throat muscles.15 to 30 minutes after the administration of antivenom, the patient's ptosis improved in about six hours, his neurotoxicity was completely reversed.The swelling around the bite site and the neurological signs usually points towards a cobra bite in tropical countries.The activated receptor will release calcium into the cell and cause muscular contraction.They are found in tropics and subtropics in Asia, Africa, Australia and America.The necrosis or cellular death will cause blisters and ulcers.The arterial blood gas study showed that the body was in severe acidosis due to respiratory failure.We intubated the patient and connected it to a ventilator to prevent an impending respiratory arrest.This antagonizing or blocking effect of neurotoxins causes muscle paralysis.Then the patient will develop double vision due to the paralysis of ocular muscles.Finally, when the respiratory muscles are paralyzed, the patient will gradually stop breathing.I at once checked his feet and saw a considerable swelling around the ankle.