Sampson Christopher Scott, Schwarz Evan
University of Missouri School of Medicine, Department of Emergency Medicine, Columbia, Missouri.
Washington University School of Medicine in Saint Louis, Department of Emergency Medicine, Saint Louis, Missouri.
Clin Pract Cases Emerg Med. 2023 Aug;7(3):178-181. doi: 10.5811/cpcem.1463.
Angiotensin converting enzyme inhibitors (ACEI) are a common class of medications prescribed to patients for hypertension. Anti-hypertensive use is not normally considered an important factor when treating patients with crotalid envenomations; however, in combination with the venom in this patient, it may have resulted in angioedema.
A 65-year-old male on ACEI presented to his community emergency department following a snake envenomation to his thumb. Six vials of Crotalidae polyvalent immune fab were administered, and he was transferred to a referral center. Approximately 18 hours after the envenomation, the patient complained of tongue swelling and difficulty speaking. There was evidence of angioedema, with the right side of the tongue significantly enlarged compared to the left. He was intubated for airway protection and remained on a ventilator for three days.
Angiotensin converting enzyme inhibitors may potentiate the effects of exogenous bradykinin as some snake venom has naturally occurring bradykinin, which may further amplify its effects. Extra vigilance may be warranted for the development of angioedema in patients receiving ACEI.
血管紧张素转换酶抑制剂（ACEI）是一类常用于治疗高血压患者的药物。在治疗被响尾蛇咬伤的患者时，通常不认为抗高血压用途是一个重要因素；然而，在该患者中，它与毒液共同作用，可能导致了血管性水肿。
一名65岁男性正在服用ACEI，其拇指被蛇咬伤后前往社区急诊科就诊。给他注射了六瓶抗响尾蛇毒多价免疫Fab片段，并将他转至一家转诊中心。咬伤后约18小时，患者主诉舌头肿胀且说话困难。有血管性水肿的迹象，舌头右侧比左侧明显肿大。为保护气道给他进行了插管，并在呼吸机上维持了三天。
血管紧张素转换酶抑制剂可能会增强外源性缓激肽的作用，因为某些蛇毒中天然存在缓激肽，这可能会进一步放大其作用。对于正在接受ACEI治疗的患者，可能需要格外警惕血管性水肿的发生。
