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Severe hypertension in elapid envenomation
Ramachandran Meenakshisundaram1, Subramanian Senthilkumaran, Martin Grootveld
1Department of Emergency and Critical Care Medicine, Sri Gokulam Hospitals and Research Institute, 3/60, Meyyanur Road, Salem, Tamil Nadu, India ; Chennai Medical College Hospital and Research Centre, Irungalur, Trichy, Tamil Nadu, India ; Institute for Materials Research and Innovation, University of Bolton, Deane Street, Bolton BL3 5AB, United Kingdom.
Severe hypertension after snakebite, particularly from kraits in India, can be linked to autonomic dysfunction. Prompt treatment with antivenom (ASV) helped manage blood pressure in these rare cases.
Area of Science:
- Clinical Toxicology
- Neurotoxicology
- Emergency Medicine
Background:
- Snakebite envenomation is a significant medical emergency in India.
- Autonomic dysfunction following snakebite is an uncommon presentation.
- Krait bites, a type of elapid envenomation, are prevalent in South India.
Purpose of the Study:
- To report three rare cases of snakebite presenting with severe hypertension.
- To investigate the potential role of snake venom-induced dysautonomia in hypertension.
- To highlight clinical and therapeutic challenges in managing such emergencies.
Main Methods:
- Case series presentation of three patients with snakebite.
- Monitoring of blood pressure (BP) and response to treatment.
- Administration of intravenous nitroglycerin (NTG) and antisnake venom (ASV).
Main Results:
- All three patients exhibited severe hypertension requiring NTG.
- A significant decrease in BP was observed after ASV administration.
- These findings suggest a possible link between snake venom and dysautonomia causing hypertension.
Conclusions:
- Snake venom-induced dysautonomia may contribute to severe hypertension in snakebite victims.
- Krait bites should be considered in the differential diagnosis of unexplained severe hypertension.
- Effective management in resource-limited settings requires awareness of these rare presentations.
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