@article{ref1,
title="Envenoming by king cobras (Ophiophagus hannah) in Vietnam with cardiac complications and necrotizing fasciitis",
journal="Toxicon: Journal of the International Society on Toxinology",
year="2021",
author="Le, Hung Quoc and Thuy Nguyen, Ngan Thi and Anh Vo, Tho Ngoc and Van Nguyen, Thuan and Ngoc Do, Khanh Thi and Chi Ho, Thanh Thi and Nguyen, Sang Ngoc and Phan, Xuan Thi and Minh Nguyen, Duy Ly and Kieu, Dung Ngoc and Ngo, Hiep Duc and Warrell, David A.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="King Cobra (Ophiophagus hannah) bite is well-known for its potentially fatal neurotoxicity. However, fatalities still occur, despite specific antivenom and respiratory support. Cardiovascular disturbances, which have attracted little attention in published reports of O. hannah envenoming, could contribute to fatality. We present two cases of confirmed O. hannah envenoming in Southern Vietnam in which there were cardiac abnormalities including arrhythmias and electrocardiographic changes, as well as elevated markers of myocardial damage. Cardiac pacing was required. One patient developed critical multi-organ dysfunctions partly explained by extensive necrotizing fasciitis/myositis originating from an Aeromonas sobria wound infection. This resulted in rhabdomyolysis, disseminated intravascular coagulation and acute kidney injury. Specific antivenom reversed neurotoxic effects of envenoming. Additional therapeutic interventions included antibiotics, surgical debridement, continuous renal replacement therapy and therapeutic plasma exchange. Both patients eventually made full recoveries. Apart from the critical problem of rapidly evolving and severe neurotoxicity, our case reports also emphasises the risk of cardiotoxic envenoming, and the complications of an overwhelming secondary bacterial wound infection. We suggest a practical approach to diagnosis and management.<p /> <p>Language: en</p>",
language="en",
issn="0041-0101",
doi="10.1016/j.toxicon.2021.07.007",
url="http://dx.doi.org/10.1016/j.toxicon.2021.07.007"
}