Delayed-onset Angioedema Following a Snakebite in a Patient on ACE Inhibitors: A Case Report.

Area of Science:

• Toxicology
• Pharmacology
• Emergency Medicine

Background:

• Angiotensin converting enzyme inhibitors (ACEI) are widely used for hypertension.
• The role of antihypertensives in treating snake envenomations is typically not a primary consideration.
• This case explores a potential interaction between ACEI and crotalid envenomation.

Purpose of the Study:

• To report a case of angioedema in a patient treated with ACEI following a snake envenomation.
• To investigate the potential mechanism by which ACEI may influence the severity of snakebite reactions.

Main Methods:

• A 65-year-old male patient on ACEI presented with a crotalid envenomation.
• The patient received Crotalidae polyvalent immune Fab for the envenomation.
• The patient subsequently developed angioedema, requiring intubation for airway protection.

Main Results:

• The patient developed significant angioedema, including tongue swelling and speech difficulty, approximately 18 hours post-envenomation.
• Airway protection was necessary, leading to intubation and mechanical ventilation for three days.
• This adverse event suggests a potential interaction between ACEI and snake venom components.

Conclusions:

• ACEI may potentiate the effects of bradykinin, a component found in some snake venoms.
• The combined effect of ACEI and venom-derived bradykinin may amplify angioedema.
• Clinicians should exercise increased vigilance for angioedema in patients on ACEI who experience snake envenomation.