Pulmonary oedema complicating snake bite due to Bungarus caeruleus

Agarwal R, Singh AP, Aggarwal AN
Correspondence: Dr Ritesh Agarwal, riteshpgi@gmail.com; ritesh@indiachest.org

ABSTRACT
Cardiotoxicity is an unusual manifestation of severe neurotoxic snake envenoming and is previously unreported with snake bites due to kraits. We describe a 26-year-old male Indian farmer who developed cardiogenic pulmonary oedema after neurotoxic snake envenoming by Bungarus caeruleus (Indian krait). We also review the literature on cardiac manifestations, the possible mechanisms and treatment of patients with cardiotoxicity accompanying neurotoxic snake envenoming. Cardiac involvement can complicate the course of snakebites. Recognition of cardiac involvement can warn the emergency physician and intensivist to be cautious, and anticipate the complications, such as pulmonary oedema, so that they can be rapidly and appropriately managed.

Keywords: Bungarus caeruleus, cardiotoxicity, indian krait, neurotoxins, pulmonary oedema, snack antivenin, snake bite, snake envenoming
Singapore Med J 2007; 48(8): e227–e230