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Indian Pediatr 2013;50: 613-614 |
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Management of Severe Scorpion Sting at a Rural
Hospital
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Santosh Govind Rathod and Sejal Bhanudas Tambat
Cottage Hospital Mangaon, Morba Road, Dist. Raigad,
Maharashtra 402 104, India.
Email:
[email protected]
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Severe scorpion sting is a life threatening accident not
uncommon in Western Maharashtra [1]. Scorpion venom delays
closing of sodium neuronal channel resulting in liberation
of endogenous catecholamines into circulation, manifesting
as "autonomic storm" [2]. In the past, upto 30% fatality due
to refractory heart failure due to Mesobuthus tamulus
envenoming has been reported. Since the advent of prazosin,
a postsynaptic alpha blocker, the fatality due to refractory
heart failure has reduced to less than 4-8% in pediatric age
group [3].
Cottage Hospital is a public health
institute situated on Mumbai-Goa highway. The mono specific
scorpion antivenom against the Mesobuthaus tumulus is
prepared at Haffkine Institute, Mumbai has been available at
our Institution since 2010. We retrospectively analyzed
details of 12 children who suffered autonomic storm due to
scorpion sting (Table I). Of these, six (2
males) had received scorpion antivenom plus prazosin and
the remaining (3 males) received only scorpion antivenom.
All gave history of scorpion sting and relatives brought the
killed specimen.
TABLE I Characteristics of Children with Autonomic Storm (N=12)
Treatment |
Anti-scorpion |
AScV +
|
|
venom (AScV) |
Prazosin |
Age (y) |
9 (7-12) |
8.8 (3-13) |
Time between
sting to |
|
|
hospitalization
(hours) |
2.41 (1-3.5) |
1.5 (1-2.5) |
Blood
pressure ( mm Hg) |
|
|
Systolic |
140 (80-190) |
123 (90-170) |
Diastolic |
80 (60-100) |
80 (70-100) |
Pulse rate
(per min.) |
89 (68-110) |
89 (84-100) |
AScV dose* |
2.33
((2-5)vial) |
1.33
((1.2)vial) |
Pulmonary
edema |
3 |
0 |
Recovery |
3 |
6 |
Time for
recovery (h) |
7.1 (4-8) |
3.75 (2-5) |
*1
vial=10 mL; Values in mean (range); Ascv-Anti-Scorpion
venom. |
Alpha receptor stimulation plays
important role in the pathogenesis of acute pulmonary edema.
Prazosin, by blocking alpha receptors corrects the abnormal
hemodynamic, and metabolic effects of circulating
catecholamines [3,4]. Patients treated with prazosin alone
are reported to recover in 10-24 hours, till the venom is
metabolized by body. In such situation victims needs close
monitoring in intensive care [8]. 10-20% of children,
irrespective of oral prazosin, were found to develop
tachycardia, hypotension and pulmonary edema [8]. Scorpion
antivenom neutralizes the circulating venom and it has no
action in reverseing the effects of already raised
catecholamine and tissue-bound venom [5]. Cold extremities
occur due to alpha receptor stimulation as a result of
vasoconstriction, and delay the venom absorption in
circulation from site of sting, which acts as depot.
Simultaneous use of oral prazosin, which antagonizes the
catecholamine actions and improves the peripheral
circulation and rapid absorption of venom in circulation
that becomes accessible to already circulating antivenom,
thus recovery is shortened in prazosin pluse antivenom group
as compared to scorpion anti venom grop alone [5]. Rapid
recovery of victims treated with prazosin and antivenom
prevent the extra load of these cases to intensive care
unit, which is beyond the reach of poor people.
References
1. Santhannakrishnan BR, Ranganathan G,
Anaantha-subramanian P, Balagopal Raju V. Cardiovascular
manifestations of scorpion sting in children. Indian Pediatr.
1977;14:353-6.
2. Gwee MCE, Nirthanan S, Khoo H,
Gopalkrishnakone P, Kini MR, Cheath LS. Autonomic effects of
same scorpion venoms an toxins. Clin Experim Pharmacol
Physiol. 2002;29:795-801.
3. Mahadevan S. Scorpion sting. Indian
Pediatr. 2000;37:504-14.
4. Bawaskar HS, Bawaskar PH. Indian red
scorpion envenoming. Indian J Pediatr. 1998;65:383-91.
5. Bawaskar HS. Efficacy and safety of scorpion antivenom
plus prazosin compared with prazosin alone for venomous,
scorpion (Mesobuthus tamulus)_ sting:_randomized open
lable clinical trial. BMJ.2010;341:C7136.
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