Sudden cardiac arrest following intravenous antibiotic administration

Kalaiselvi^1*, Subathra Devi². M, Maha Lakshmi³

¹Nursing Supervisor, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

²Nurse Educator , Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

³Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

*Correspondence

Abstract

A patient presented with a one-day history of fever and a ten-day history of cold, cough, and expectoration. On admission, the patient was conscious, oriented, and hemodynamically stable. Clinical evaluation and investigations were suggestive of left lower lobe pneumonitis. Empirical antibiotics, nebulization therapy, antiviral medications, and supportive treatment were initiated. However, during the administration of intravenous Cefoperazone–Sulbactam following a test dose, the patient suddenly developed severe bradycardia that rapidly progressed to cardiac arrest. Immediate resuscitative measures were initiated according to Advanced Cardiac Life Support (ACLS) protocols. This reporte highlights the importance of close monitoring during antibiotic administration, early recognition of adverse drug reactions, and prompt intervention to improve patient outcomes.

Keywords: Advanced Cardiac Life Support; Cefoperazone–Sulbactam

Introduction

Pneumonitis is a common lower respiratory tract infection that often requires prompt treatment with empirical antibiotics and supportive care. Although antibiotics such as Cefoperazone–Sulbactam are widely used and generally considered safe, rare but life-threatening adverse reactions, including severe hypersensitivity reactions, profound bradycardia, and cardiac arrest, may occur. Early identification of these complications and immediate resuscitative management are essential to improve survival. This report describes the sudden onset of bradycardia and cardiac arrest during intravenous antibiotic administration in a patient admitted with left lower lobe pneumonitis, highlighting the need for vigilance during drug administration.

Case presentation

The patient presented with a history of fever for one day and cold, cough, and expectoration for ten days. On admission, the patient was conscious, oriented, and hemodynamically stable. Clinical evaluation and investigations were suggestive of left lower lobe pneumonitis. The patient started on empirical antibiotics, nebulization therapy, antiviral medications, and other supportive treatment. During the administration of intravenous Cefoperazone–Sulbactam, following a test dose, the patient suddenly developed bradycardia, which rapidly progressed to cardiac arrest.

Relevant clinical findings

Social history: Nil
Allergies: Nil
Past medical history: Chronic Obstructive Pulmonary Disease (COPD), Type 2 Diabetes Mellitus (T2DM), Benign Prostatic Hyperplasia (BPH), Dyslipidemia, Cholelithiasis, and Cholecystitis.
Past surgical history: Pigtail catheter placement in December 2025.

Physical examinations

The patient was conscious, oriented, and clinically stable.

Blood Pressure	140/90 mmHg
Heart Rate	98/min
Respiratory Rate	20/min
SpO₂	94% on room air
GCS	15/15

Relevant Investigation

Complete blood count
Hemoglobin	10.8 g/dL
Total Count	8,800 cells/mm³
Platelet Count	2,42,000/mm³
AST	17 U/L
ALT	10 U/L
Albumin	2.4 g/dL
ABG Analysis
pH	7.01
PCO₂	88 mmHg
PO₂	69 mmHg
HCO₃	22.2 mmol/L
Lactate	10.2 mmol/L
Sodium	140 mmol/L
Potassium	4.3 mmol/L
Chloride	104 mmol/L
Ionized Calcium	0.88 mmol/L
Base Excess	-10.1
O₂ Saturation	88.40%
Hematocrit	35%

Diagnosis

Severe mixed respiratory and metabolic acidosis
Hypercapnic respiratory failure
Lactic acidosis
Hypoxemia
Pneumonitis

Management

Cefoperazone-Sulbactam 3 g IV BD
Antiflu 75 mg BD
Azee 500 mg BD
Sompraz 40 mg OD
Dolo 650 mg BD
Nebulization Duoline nebulization TDS, Budecort nebulization TDS

At approximately 9:30 PM, an intravenous infusion of Cefoperazone-Sulbactam diluted in 100 mL of Normal Saline was initiated following the administration of a test dose. After approximately 50 mL of the antibiotic infusion had been administered, the patient suddenly developed severe bradycardia, which rapidly progressed to cardiac arrest. Resuscitative measures were initiated immediately in accordance with the Advanced Cardiac Life Support (ACLS) protocol. High-quality cardiopulmonary resuscitation (CPR) commenced promptly, along with advanced airway management and airway protection. The following emergency medications were administered during resuscitation: Inj. Adrenaline every 3–5 minutes, Inj. Sodium Bicarbonate 50 mL stat, Inj. Hydrocortisone 100 mg stat, and Inj. 25% Dextrose 100 mL stat. CPR was initiated at 9:40 PM and continued until 10:10 PM. Despite prolonged and comprehensive resuscitative efforts, Return of Spontaneous Circulation (ROSC) could not be achieved. The patient was declared deceased at 10:17 PM.

Out come

The patient suffered sudden cardiopulmonary arrest during intravenous antibiotic administration and could not be revived despite aggressive resuscitative measures following ACLS protocol.
Probable Causes of Death
Acute Myocardial Infarction
Possible Anaphylactic Shock secondary to antibiotic administration
Severe respiratory acidosis with hypercapnic respiratory failure
Underlying COPD and lower respiratory tract infection
Metabolic acidosis with elevated lactate
Multiple comorbid illnesses including T2DM and Dyslipidemia

Nursing Management:

Performed initial assessment and monitored vital signs.
Administered oxygen therapy and prescribed medications.
Monitored the patient closely during intravenous antibiotic administration.
Stopped the Cefoperazone–Sulbactam infusion immediately after the onset of bradycardia.
Activated the Code Blue team and informed the treating physician.
Initiated high-quality CPR as per ACLS protocol.
Assisted with airway management, emergency medications, and continuous ECG monitoring.
Provided post-resuscitation care and haemodynamic monitoring.
Documented the event, interventions, and patient’s response accurately.
Reported the suspected adverse drug reaction as per hospital policy.

Discussion

This case demonstrates a rare but serious adverse event that occurred during intravenous Cefoperazone–Sulbactam administration. Although the patient was conscious and haemodynamically stable on admission, sudden bradycardia followed by cardiac arrest developed during the antibiotic infusion despite a test dose. Early recognition of the patient’s deterioration, immediate discontinuation of the infusion, prompt initiation of CPR according to ACLS guidelines, and timely emergency management were essential. This case emphasizes the importance of close monitoring during intravenous antibiotic administration, early identification of adverse drug reactions, and rapid intervention to improve patient safety and outcomes

Conclusion

This case highlights that even after administering a test dose, a patient may develop a sudden and life-threatening adverse reaction during intravenous antibiotic administration. Early recognition of bradycardia, immediate discontinuation of the drug, prompt activation of the Code Blue team, and timely initiation of ACLS protocols were essential in managing the emergency. This case emphasizes the importance of close monitoring during antibiotic administration, rapid emergency response, accurate documentation, and reporting of suspected adverse drug reactions to enhance patient safety and improve clinical outcomes.

Sudden cardiac arrest following intravenous antibiotic administration

Sudden cardiac arrest following intravenous antibiotic administration

Kalaiselvi1*, Subathra Devi2. M, Maha Lakshmi3

Nightingale Journals

Kalaiselvi^1*, Subathra Devi². M, Maha Lakshmi³