Probable Ophiophagus sp. envenomation with cardiopulmonary arrest: sequential antivenom escalation in the Philippines

Snakebite envenomation remains a leading cause of preventable mortality in Southeast Asia. We report a 52-year-old woman from Leyte, Philippines, who sustained a bite from a probable king cobra (Ophiophagus sp.) and arrived at a tertiary center in cardiopulmonary arrest. Return of spontaneous circulation was achieved after a single resuscitation cycle. Initial treatment with Purified Cobra Antivenom, a monovalent product directed against Naja philippinensis, produced only minimal improvement. Escalation to Taradoc® (VINS Bioproducts Limited, India), a trivalent antivenom with additional coverage for Ophiophagus sp., was followed by progressive neurologic recovery, extubation on hospital day 3, and discharge without deficits. This case illustrates the potential role of polyvalent antivenom escalation in elapid envenomation refractory to monovalent therapy.