Persistent hypoglycemia following a Gila monster（Heloderma suspectum）bite：A case report

Abstract

A 30-year-old female zookeeper was bitten on the fourth finger of her right hand by a Gila monster（Heloderma suspectum） during routine handling. She subsequently developed systemic symptoms requiring hospitalization. She presented with severe local pain and swelling at the bite site, accompanied by nausea and fatigue. Laboratory tests at admission revealed leukocytosis and rapidly declining blood glucose levels （from 159 to 70 mg/dL within 3 h after envenomation）. These symptoms, particularly those of prolonged hypoglycemia, were attributed to exendin-4, a potent glucagon-like peptide-1 receptor agonist present in the saliva of this venomous lizard. The patient was successfully stabilized following intensive fluid resuscitation and continuous glucose infusion. She was discharged on day 4 postadmission. This rare case of H. suspectum envenomation highlights the criticality of rigorous glucose monitoring and comprehensive supportive care to mitigate the risk of delayed and persistent hypoglycemia and circulatory instability induced by bioactive venom peptides.