A case of cardiac arrest induced by anti-snake venom administration after an unidentified bite

Kanugula S, Avirendla S

Pdf Page Numbers :- 314-316

Shivaraju Kanugula^1,* and Sony Avirendla¹

¹Department of General Medicine, Krishna Institute of Medical Sciences, Minister Road, Secunderabad-500003, Telangana, India

*Corresponding author: Dr. K. Shiva Raju, Department of Internal Medicine, Krishna Institute of Medical sciences, Minister Road, Secunderabad 500003, Telangana, India. Email: shivaraju.doctor@gmail.com

Received 11 March 2025; Revised 2 June 2025; Accepted 10 June 2025; Published 18 June 2025

Citation: Kanugula S, Avirendla S. A case of cardiac arrest induced by anti-snake venom administration after an unidentified bite. J Med Sci Res. 2025; 13(3):314-316. DOI: http://dx.doi.org/10.17727/JMSR.2025/13-56

Copyright: © 2025 Kanugula S et al. Published by KIMS Foundation and Research Center. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Background: Each year, an estimated 5.4 million snakebites occur globally, resulting in 1.8–2.7 million cases of envenoming and 81,000–138,000 deaths. Sub-Saharan Africa, Southeast Asia, and South Asia are the most affected regions, with India alone reporting nearly 45,900 snakebite-related deaths annually. Patients with clinical signs of envenomation are generally treated with an initial dose of 10 vials of polyvalent anti-snake venom (ASV), with repeat doses administered if symptoms persist. Whole blood clotting time (WBCT 20) is used to monitor treatment response.

Case presentation: We report the case of a 57-year-old female who presented with a history suggestive of snakebite envenomation. Approximately one hour after hospital admission, she developed sudden cardiac arrest. Cardiopulmonary resuscitation (CPR) was initiated, resulting in return of spontaneous circulation (ROSC). She was shifted to the intensive care unit (ICU) and started on dobutamine and furosemide infusions. A 2D echocardiogram revealed regional wall motion abnormalities (RWMA) involving the LAD, RCA, and LCX territories, with a left ventricular ejection fraction (LVEF) of 35%. Laboratory findings showed leukocytosis (WBC count 14,300/mm³) and elevated cardiac biomarkers. Cardiology consultation was sought, and the patient was managed with norepinephrine, dobutamine, vasopressin infusion, diuretics, and guideline-directed medical therapy (GDMT), following which she gradually stabilized.

Conclusion: This case highlights a rare presentation of cardiac arrest following ASV administration, likely due to severe anaphylaxis. Early recognition of envenomation, prompt initiation of ASV therapy, close monitoring for complications, and timely resuscitative efforts are critical in improving outcomes in snakebite victims.

Keywords: unidentified bite; ASV administration; cardiac arrest; guideline-directed medical therapy; recovery