Cardiovascular manifestations of severe scorpion sting in India
Scorpion envenoming is common in many parts of the world. Primary health centers where medical aid is first sought by villagers record the highest incidence of sting. The scorpion which stung or patients was Mesobuthus tamulus (formerly buthus or buthotus tamulus), the red scorpion. Its venom is a potent autonomic stimulator, resulting in the sudden pouring of endogenous catecholamines into the bloodstream. The mechanism of myocardial failure and pulmonary edema has been investigated and attributed to the venom–induced increase in the systemic arterial impedance, decreased left ventricular compliance and bradycardia tachycardia syndrome. Systolic dysfunction plays a role in the pathogenesis of heart failure in scorpion envenoming. The beneficial effects of nifedipine and prazosin hydrochloride on cardiovascular manifestations justify the routine use of vasodilation in children with cardiovascular manifestations after scorpion envenoming.
We report here our clinical experience of 34 victims of scorpion sting.
Scorpion sting in children is a hazardous and potentially fatal condition. Of 34 children admitted to hospital in mahad, maharashtra state, India following scorpion sting, 14 had hypertension (130/90–170/130 mmHg), five had myocardial failure, acute pulmonary edema developed in nine, two had tachycardia (110–1200/min) and four died. Analysis of data suggests that cardiovascular morbidity and mortality depend upon the time lapse between sting and administration of vasodilators.
Current management of human scorpionism consists of early admission to hospital and immediate reduction of raised blood pressure with sublingual nifedipine while peripheral action of venom is antagonized by the post–synaptic alpha blocker prazosin, in addition, digoxin, frusemide, aminophylline and oxygen are administered. The patient is kept under close surveillance in an intensive care unit. Massive life threatening pulmonary edema is treated with a sodium nitroprusside drip. We suggest that aggressive medical management directed at the organ system specifically affected by scorpion venom can be effective.
Review of 34 children
Dr. H. S. Bawaskar & Dr. P. H. Bawaskar
Bawaskar Hospital and Research Center,
Mahad, Maharashtra, India
(received 6 February 1991)