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Ceftriaxone is the most commonly used antibiotic in Pakistan which is well-tolerated and rarely cause fatal adverse reactions. Here, we underline a fatal cardiopulmonary arrest post-ceftriaxone administration. A nine-year-old girl was presented to the emergency department with complaints of sore throat and a small abscess on the cheek. She was prescribed ceftriaxone 0.5 g intravenously STAT (immediately) and amoxicillin syrup (125 mg/5ml) 1 tablespoon BID (twice a day) for 5 days. Earlier, the patient was alert and oriented but she had a fall and became unconscious within a minute of receiving a ceftriaxone injection. She was given emergency treatment for shock and cardiopulmonary resuscitation was performed for approximately 20 minutes. She was declared dead, with cardiopulmonary arrest reported to be the cause of death. In conclusion, this was a fatal case of cardiopulmonary arrest following anaphylaxis to ceftriaxone (Naranjo adverse drug reaction probability score = 5). Therefore, healthcare professionals should be mindful of anaphylaxis possibility in patients receiving ceftriaxone.

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Objectives: The diagnostic potential of serum asymmetric dimethylarginine (ADMA) levels as a biomarker for cardiovascular risk has been investigated in various populations, but no such study has been reported in Pakistan. This study aimed to assess the diagnostic efficiency of serum ADMA levels in detecting cardiovascular risk in patients with coronary heart disease (CHD). Methodology: A cross-sectional study was conducted at the Chaudhry Pervaiz Elahi Institute of Cardiology (CPEIC), Wazirabad, Pakistan, using a consecutive sampling technique to ensure randomization. One hundred individuals were divided into two groups (CHD patients and healthy controls), and blood samples were collected between January 2022 and November 2022. Serum ADMA levels were measured using an enzyme-linked immunosorbent assay (ELISA), and statistical analysis was performed to determine the area under the receiver operating characteristic (ROC) curve (AUC). Results: The mean age of CHD patients' serum samples was 58.6 ± 7.39 years (p<0.001) compared to 42.26 ± 14.4 years (p<0.001) in healthy controls. The mean ADMA concentration in the serum of CHD patients was determined as 1.37 ± 0.26 µmol/L (p<0.001) compared to 0.812 ± 0.207 µmol/L (p<0.001) in healthy controls. The AUC on the ROC curve was determined as 0.95, indicating high diagnostic accuracy. ADMA's sensitivity, specificity, and overall accuracy were determined as 82%, 88%, and 85%, respectively. Conclusion: In conclusion, serum ADMA levels demonstrate a promising potential as a biomarker for assessing cardiovascular risk. The findings of this study suggest that ADMA measurements could be utilized as a diagnostic tool in CHD patients, aiding in the identification and management of cardiovascular risk in the Pakistani population. Further research is warranted to validate these findings and explore the utility of ADMA in more extensive and diverse cohorts.