TY  - JOUR
PY  - 2021//
TI  - Envenoming by king cobras (Ophiophagus hannah) in Vietnam with cardiac complications and necrotizing fasciitis
JO  - Toxicon: Journal of the International Society on Toxinology
A1  - Le, Hung Quoc
A1  - Thuy Nguyen, Ngan Thi
A1  - Anh Vo, Tho Ngoc
A1  - Van Nguyen, Thuan
A1  - Ngoc Do, Khanh Thi
A1  - Chi Ho, Thanh Thi
A1  - Nguyen, Sang Ngoc
A1  - Phan, Xuan Thi
A1  - Minh Nguyen, Duy Ly
A1  - Kieu, Dung Ngoc
A1  - Ngo, Hiep Duc
A1  - Warrell, David A.
SP  - ePub
EP  - ePub
VL  - ePub
IS  - ePub
N2  - 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>
LA  - en
SN  - 0041-0101
UR  - http://dx.doi.org/10.1016/j.toxicon.2021.07.007
ID  - ref1
ER  -