Emergency and Trauma Department, Hospital Umum Sarawak, Kuching, Sarawak, Malaysia.
Emergency and Trauma Department, Hospital Melaka, Melaka, Malaysia.
Toxicon. 2024 Nov 6;250:108099. doi: 10.1016/j.toxicon.2024.108099. Epub 2024 Sep 10.
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.
在马来西亚，因被眼镜蛇属物种咬伤而向远程毒蛇咨询服务中心咨询是最常见的情况。被眼镜蛇属物种咬伤可能导致神经麻痹和心脏毒性作用，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。我们报告了一例赤道喷毒眼镜蛇，即食蟹眼镜蛇咬伤后出现的早期心脏毒性表现，早于早期麻痹性中毒表现。一名 14 岁男孩因轻度局部中毒到急诊就诊。心电图显示多发性室性期前收缩。随后患者出现上睑下垂。给予适当的抗蛇毒血清后，上睑下垂完全缓解，窦性节律恢复正常。患者在住院两天后康复出院。患者的心电图表现和神经毒性表现提示急性全身性中毒。建议保持高度警惕心脏毒性，并进行密切的连续监测，以确保及时给予抗蛇毒血清。
