Multiple ventricular premature complexes following equatorial spitting cobra (Naja sumatrana) envenomation

IF 2.6 4区医学 Q2 PHARMACOLOGY & PHARMACY

Toxicon Pub Date : 2024-09-10 DOI:10.1016/j.toxicon.2024.108099

Kim Hoon Choo , Anisah binti Adnan , Ahmad Khaldun Ismail

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Abstract

Naja species bite is the commonest cause for consultation to Remote Envenomation Consultancy Services in Malaysia. Envenomation by Naja species may result in neuroparalysis and cardiotoxic effects including arrhythmias, hypertension, tachycardia, atrioventricular blocks, ventricular tachycardia, and ventricular fibrillation. We report a case of cardiotoxicity as an early manifestation following an equatorial spitting cobra, Naja sumatrana bite, preceding early paralytic envenomation manifestation. A 14-year-old boy presented to an emergency department with mild local envenomation. ECG showed multiple ventricular premature complexes. Subsequently patient developed ptosis. Complete resolution of ptosis and resumption of normal sinus rhythm occurred following administration of the appropriate antivenom. The patient was discharged well after two days of hospitalization. The patient's ECG findings and neurotoxic manifestation suggested acute systemic envenomation. High index of suspicion for cardiotoxicity with close serial monitoring is recommended to ensure timely administration of antivenom.

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赤道喷火眼镜蛇（Naja sumatrana）中毒后的多发性室性早搏综合征

在马来西亚，Naja物种咬伤是最常见的远程虫媒传染咨询服务咨询原因。被眼镜蛇咬伤可能导致神经麻痹和心脏毒性反应，包括心律失常、高血压、心动过速、房室传导阻滞、室性心动过速和心室颤动。我们报告了一例被赤道喷吐眼镜蛇（Naja sumatrana）咬伤后早期表现为心脏毒性的病例，该病例在早期麻痹性中毒表现之前就出现了心脏毒性。一名 14 岁男孩因局部轻度中毒到急诊科就诊。心电图显示多发性室性早搏。随后患者出现上睑下垂。注射适当的抗蛇毒血清后，上睑下垂完全缓解，窦性心律恢复正常。住院两天后，患者康复出院。患者的心电图结果和神经毒性表现表明其为急性全身性蛇毒中毒。建议高度怀疑心脏毒性并进行密切的连续监测，以确保及时使用抗蛇毒血清。

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来源期刊

Toxicon 医学-毒理学

CiteScore

4.80

自引率

10.70%

发文量

358

审稿时长

68 days

期刊介绍： Toxicon has an open access mirror Toxicon: X, sharing the same aims and scope, editorial team, submission system and rigorous peer review. An introductory offer Toxicon: X - full waiver of the Open Access fee. Toxicon''s "aims and scope" are to publish: -articles containing the results of original research on problems related to toxins derived from animals, plants and microorganisms -papers on novel findings related to the chemical, pharmacological, toxicological, and immunological properties of natural toxins -molecular biological studies of toxins and other genes from poisonous and venomous organisms that advance understanding of the role or function of toxins -clinical observations on poisoning and envenoming where a new therapeutic principle has been proposed or a decidedly superior clinical result has been obtained. -material on the use of toxins as tools in studying biological processes and material on subjects related to venom and antivenom problems. -articles on the translational application of toxins, for example as drugs and insecticides -epidemiological studies on envenoming or poisoning, so long as they highlight a previously unrecognised medical problem or provide insight into the prevention or medical treatment of envenoming or poisoning. Retrospective surveys of hospital records, especially those lacking species identification, will not be considered for publication. Properly designed prospective community-based surveys are strongly encouraged. -articles describing well-known activities of venoms, such as antibacterial, anticancer, and analgesic activities of arachnid venoms, without any attempt to define the mechanism of action or purify the active component, will not be considered for publication in Toxicon. -review articles on problems related to toxinology. To encourage the exchange of ideas, sections of the journal may be devoted to Short Communications, Letters to the Editor and activities of the affiliated societies.