Case reports

N. haje, or N. anchietae
Nigeria (and review of the literature): Warrell et al. 1976a.
South Africa (described as N. haje, but actually N. anchietae!):  Visser and Chapman 1978: bites in humans and in particular fatalities appear to be rare.

N. guineensis (described as N. melanoleuca)
Liberia: Stahel 1980.

N. nivea
South Africa: Blaylock et al. 1985.

Signs & symptoms

Local effects

N. haje
Minimal local effects (Warrell et al. 1976a).

N. nivea
Minimal local effects (Blaylock et al. 1985).

Neurological effects

N. haje
Peripheral signs of paralysis (ptosis and signs and symptoms of other cranial nerve paralyses, paralysis of the extremities, paralysis of the respiratory musculature) (Warrell et al. 1976a).

N. guineensis
Ptosis, dysarthria, dyspnoea (Stahel 1980).

N. nivea
Peripheral signs of paralysis (ptosis and signs and symptoms of other cranial nerve paralyses, paralysis of the extremities, paralysis of the respiratory musculature) (Blaylock et al. 1985).

First aid

Compression-immobilisation method, as neurological effects arise extremely quickly and can lead to respiratory insufficiency.

Treatment (symptomatic)

Endotracheal intubation, artificial respiration.
Indications: danger of aspiration/respiratory insufficiency.

Treatment (specific)

Antivenoms
Polyvalent antivenom (SAIMR, Johannesburg)

Dose

N. haje
Initial dose 100 ml (Warrell et al. 1976a).

N. nivea
Initial dose 80–100 ml (Blaylock et al. 1985).

Indications for administration of antivenom
Progressive signs of paralysis, respiratory insufficiency.

Efficacy
Apparently only efficacious when administered early on, i.e. before manifestation of signs of paralysis (Blaylock et al. 1985).