{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T04:10:48Z","timestamp":1788667848431,"version":"build-2803163510"},"reference-count":24,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T00:00:00Z","timestamp":1788393600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"Public Promoting Association Kura Foundation"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Wilderness &amp; Environmental Medicine"],"abstract":"<jats:p>\n                    <jats:italic toggle=\"yes\">Naja samarensis<\/jats:italic>\n                    , a World Health Organization Category 1 venomous snake endemic to the Philippines, causes neurotoxic envenomation, but cardiac complications are rarely documented. Case 1 is a 71-y-old hypertensive male who presented with altered consciousness, ptosis, and dysarthria. Following antivenom administration, he developed supraventricular tachycardia (180 beats\/min) requiring adenosine. He recovered after 16 ampules of purified cobra antivenom and was discharged on Day 5. Case 2 is a 66-y-old hypertensive male who presented with neurotoxic symptoms and atrial fibrillation (180 beats\/min). Following administration of Taradoc, he acutely deteriorated with hypotension and recurrent atrial fibrillation (200 beats\/min), requiring another cardioversion. He subsequently developed progressive pulmonary edema and respiratory failure, leading to death. Case 3 is a 50-y-old female who presented with neurotoxic symptoms, chest heaviness, and elevated troponin (2\u2005ng\u00b7mL\n                    <jats:sup>\u20131<\/jats:sup>\n                    ). Electrocardiogram revealed ST elevation, suggesting myocardial injury. Following neostigmine administration, neurotoxic symptoms improved, although dyspnea on exertion persisted. Species identification was based on the reported snake appearance (black and yellow coloration), geographic distribution of venomous snakes in Eastern Visayas, and clinical presentation consistent with neurotoxic cobra envenomation. No snake specimens were physically available for species verification in any of the 3 cases.\n                    <jats:italic toggle=\"yes\">N samarensis<\/jats:italic>\n                    envenomation may be associated with life-threatening cardiac complications, including tachyarrhythmia and myocardial injury. Management priorities include the use of antivenoms with established efficacy, differentiation of venom-induced myocardial injury from acute coronary syndrome, and continuous electrocardiographic monitoring with cardiac biomarker assessment.\n                  <\/jats:p>","DOI":"10.1177\/10806032261481060","type":"journal-article","created":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T16:04:34Z","timestamp":1788451474000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Cardiac Manifestations Following Suspected Cobra (\n                    <i>Naja samarensis<\/i>\n                    ) Bites in Eastern Visayas, Philippines: A Case Series"],"prefix":"10.1177","author":[{"given":"Jonathan","family":"Paghubasan","sequence":"first","affiliation":[{"name":"Eastern Visayas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2011-485X","authenticated-orcid":false,"given":"Yoshihiro","family":"Aoki","sequence":"additional","affiliation":[{"name":"Nagasaki University Hospital"},{"name":"School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick Joseph","family":"Tiglao","sequence":"additional","affiliation":[{"name":"Philippine Toxinology Society, Manila, Philippines"},{"name":"University of the Philippines\u2013Philippine General Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariedel A.","family":"Tan","sequence":"additional","affiliation":[{"name":"Eastern Visayas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9091-6300","authenticated-orcid":false,"given":"Mardie S.","family":"Sarsalijo","sequence":"additional","affiliation":[{"name":"Eastern Visayas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grace Joy B.","family":"Aquino","sequence":"additional","affiliation":[{"name":"Eastern Visayas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercy Grace B.","family":"Uraga","sequence":"additional","affiliation":[{"name":"Eastern Visayas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clier A.","family":"Babon-Malbas","sequence":"additional","affiliation":[{"name":"Eastern Visayas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria Rizza D.","family":"Devora","sequence":"additional","affiliation":[{"name":"Eastern Visayas Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,9,3]]},"reference":[{"key":"e_1_3_2_2_2","volume-title":"Guidelines for the Management of Snakebites. 2nd ed","author":"World Health Organization, Regional Office for South-East Asia","year":"2016","unstructured":"World Health Organization, Regional Office for South-East Asia. Guidelines for the Management of Snakebites. 2nd ed. World Health Organization; 2016."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2022.107008"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1093\/trstmh\/trae110"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpcardiol.2021.100861"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/trstmh\/traa087"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/toxres\/tfae088"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2022.106942"},{"key":"e_1_3_2_9_2","volume-title":"Algorithms of Common Poisonings. 4th ed","author":"Cortes-Maramba NP","year":"2011","unstructured":"Cortes-Maramba NP, Panganiban LCR, Pascual JC, Dioquino CPC, Westergaard MLS, editors. Algorithms of Common Poisonings. 4th ed. National Poison Management and Control Center; 2011."},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.3109\/15563650.2012.696119"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.toxicon.2024.108099"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1159\/000495907"},{"key":"e_1_3_2_13_2","first-page":"5185716","article-title":"Cardiogenic shock due to Kounis syndrome following cobra bite","volume":"2019","author":"Priyankara WDD","year":"2019","unstructured":"Priyankara WDD, Manoj EM, Gunapala A, Ranaweera AGRMA, Vithanage KS, Sivasubramanium M, et al. Cardiogenic shock due to Kounis syndrome following cobra bite. Case Rep Crit Care. 2019;2019:5185716.","journal-title":"Case Rep Crit Care"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2020-057926"},{"key":"e_1_3_2_15_2","article-title":"King cobra and snakebite envenomation: on the natural history, human-snake relationship and medical importance of Ophiophagus hannah","volume":"27","author":"Tan CH","year":"2022","unstructured":"Tan CH, Bourges A, Tan KY. King cobra and snakebite envenomation: on the natural history, human-snake relationship and medical importance of Ophiophagus hannah. J Venom Anim Toxins Incl Trop Dis. 2022;27:e20210051.","journal-title":"J Venom Anim Toxins Incl Trop Dis"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.3389\/fphar.2021.727756"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2022.04.013"},{"key":"e_1_3_2_18_2","doi-asserted-by":"publisher","DOI":"10.1186\/s40409-017-0108-9"},{"key":"e_1_3_2_19_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-015-1426-z"},{"key":"e_1_3_2_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/0218492313501819"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijcard.2012.01.098"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1186\/s41182-025-00709-5"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1111\/bcp.12739"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.trstmh.2007.12.005"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0288723"}],"container-title":["Wilderness &amp; Environmental Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10806032261481060","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/10806032261481060","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/10806032261481060","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T03:32:47Z","timestamp":1788665567000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/10806032261481060"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,3]]},"references-count":24,"alternative-id":["10.1177\/10806032261481060"],"URL":"https:\/\/doi.org\/10.1177\/10806032261481060","relation":{},"ISSN":["1080-6032","1545-1534"],"issn-type":[{"value":"1080-6032","type":"print"},{"value":"1545-1534","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,3]]},"article-number":"10806032261481060"}}