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The Indian Journal of Pediatrics

, Volume 65, Issue 3, pp 383–391 | Cite as

Indian red scorpion envenoming

  • H. S. Bawaskar
  • P. H. Bawaskar
Symposium: Toxicology and Poisoning—II

Abstract

The clinical course and treatment outcome of scorpion envenoming in 293 children was studied in a hospital at Mahad in Raigad district of Maharastra. 111 (38%) children who reported 1–10 hours (mean 3.5 hours) after sting had hypertension, 87 (29.6%) with tachycardia reported within 1–24 hours (mean 6.7 hours) of being envenomed and 72 (24.5%) children developed acute pulmonary edema after 6–24 hours (mean 8 hours) of sting. Six victims were brought dead, while 17 (6%) died later owing to multiorgan failure with loss of consciousness and convulsions (who reported after 24 hours of sting). Early administration of prazosin (125–250 ug orally) improved the clinical symptoms. Morbidity and mortality due to scorpion envenoming depends upon time lapse between sting and administration of post synaptic α-1 blocker, prazosin hydrochloride.

Key words

Scorpion Pulmonary edema Prazosin 

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References

  1. 1.
    Amitai Y, Mines Y, Aker M, Goitein K. Scorpion sting in children.Clin Pediatr 1984; 24: 136–140.CrossRefGoogle Scholar
  2. 2.
    Waterman JA. Some notes on scorpion poisoning in Trinidad.Trans Roy Soc Trop Med Hyg 1938; 31: 607–624.CrossRefGoogle Scholar
  3. 3.
    Amaral CFS, Derezende NA, Freire-maia L. Acute pulmonary oedema afterTitus serrulatus scorpion sting in children.Am J Cardiol 1992; 71: 242–245.CrossRefGoogle Scholar
  4. 4.
    Sofer S, Shachak E, Slonin A, Gueron M. Myocardial injury without heart failure following envenomation by the scorpionLeiurus quniquestriatus in children.Toxicon 1991; 29: 382–385.PubMedCrossRefGoogle Scholar
  5. 5.
    Santhanakrishanan BK, Raju VB. Management of scorpion sting in children.J Trop Med Hyg 1974; 77: 136–139.Google Scholar
  6. 6.
    Gaitonde BB, Jadhav SS, Bawaskar HS. Pulmonary oedema after scorpion sting.Lancet 1978; i: 445–446.CrossRefGoogle Scholar
  7. 7.
    Mundle PM. Scorpion sting.Br Med J 1961; i: 1042.Google Scholar
  8. 8.
    Rajarajeswari G, Sivaprakasam S, Viswanthan J. Morbidity and mortality pattern in scorpion sting: a review of 68 cases.J Ind Med Assoc 1979; 73: 123–126.Google Scholar
  9. 9.
    Bawaskar HS. Scorpion sting and cardiovascular complications.Ind Heart J 1977; 29 (i): 228.Google Scholar
  10. 10.
    Bawaskar HS, Bawaskar PH. Prazosin in management of cardiovascular menifestations so scorpion sting.Lancet 1986; i; 510–511.CrossRefGoogle Scholar
  11. 11.
    Bawaskar HS. Diagnostic cardiac premonitory signs and symptoms of red scorpion sting.Lancet 1982; 552–54.Google Scholar
  12. 12.
    Murthy KPR, Billimoria FR, Khopkar M, Dave KN. Acute hyperglycemia and hyperkalaemia in acute myocarditis produced by scorpion (Buthus tamulus) venom injection in dogs.Ind Heart J 1986; 38 (1): 71–74.Google Scholar
  13. 13.
    Rao P, Premlatha BK, Bhatt V, Harinath PSRK. Cardiac and behavioural effects of scorpion venom in experimental animals.Ind Pediatr 1969; 6 (3): 95–101.Google Scholar
  14. 14.
    Murthy KRK, Vakil AE. Elevation of plasma angiotensin levels in dogs by Indian red scorpions (Bothus tamulus) venom and its reversal by administration of insulin + tolazoline.Ind J Med Res 1988; 88: 376–379.Google Scholar
  15. 15.
    Freire-mai L, Campos JA. Pathophysiology and treatment of scorpion poisoning in ownby CL de Natural toxins.LCGV 1989; 139–159.Google Scholar
  16. 16.
    Sofer S, Shahak E, Gueron M. Scorpion envenomation and antivenin therapy.J Pediatr 1994; 124: 973–978.PubMedCrossRefGoogle Scholar
  17. 17.
    Abroug E, Ayari M, Nouriras Set al. Assessment of left ventricular function in severe scorpion envenomation: combined hemodynamic and echodoppler study.Intensive Care Med 1995; 21: 629–635.PubMedCrossRefGoogle Scholar
  18. 18.
    Ramchandran LK, Agarwal OP, Achuthan KEet al. Fractionation and biological activities of venom of the Indian scorpionButhus tamulus andHeterometrus bengalensis.Ind Bioch Biophysic 1986; 23: 335–338.Google Scholar
  19. 19.
    Bawaskar HS, Bawaskar PH. Consecutive stings by red scorpions evokes severe cardiovascular manifestations in the first, but not in the second victim: a clinical observation.J Trop Med Hyg 1991; 94: 231–233.PubMedGoogle Scholar
  20. 20.
    Amaral CFS, Lopes JA, Magalhaes RA, De Rezende NA. Electrocardiographic enzymatic and echocardiographic evidences of myocardial damage afterTityus semrulatus scorpion poisoning.Am J Cardiol 1991; 67: 654–656.CrossRefGoogle Scholar
  21. 21.
    Gueron M, Margulus G, Sofer S. Echocardiographical radionuclide angiogrpahic observations following scorpion envenomation byLeiurus quinguestriatus.Toxicon 1990; 28: 1005–1009.PubMedCrossRefGoogle Scholar
  22. 22.
    Bawaskar HS, Bawaskar PH. Stings by red scorpion (Buthus tamulus) in Maharashtra state, India: A clinical study.Trans Roy Soc Trop Med Hyg 1989; 83: 856–860.CrossRefGoogle Scholar
  23. 23.
    Choudhury LK, Ganguly DK. Some cardiovascular effects of crude scorpion venom.Ind J Med Res 1978; 68: 15–18.Google Scholar
  24. 24.
    Gueron M, Stern J, Cohen W. Severe myocardial damage and heart failure in scorpion sting.Am J Cardiol 1967; 19: 719–726.PubMedCrossRefGoogle Scholar
  25. 25.
    Dudin AA, Cousson AR, Thalji A, Juaben I, Libden AB. Scorpion sting in children in the Jerusalem area. A review of 54 cases.Ann Trop Pediat 1991; 11: 217–223.Google Scholar
  26. 26.
    El Amin EO, Elidrissay A, Hamid HS, Sultan OM, Safar RA. Scorpion sting. A management problem.Ann Trop Pediatr 1991; 11: 143–148.Google Scholar
  27. 27.
    Dehesa-Davila M. Epidemiological characteristics of scorpion sting in Leon, Gunjuato, Mexico.Toxicon 1989; 27: 281–286.PubMedCrossRefGoogle Scholar
  28. 28.
    Zlotkin E, Shulov AS. Recent studies on the mode of action of scorpion neurotoxins: A review.Toxicon 1969; 7: 217–221.PubMedCrossRefGoogle Scholar
  29. 29.
    Strong PN. Potassium channel.Toxin Pharmacol Ther 1990; 46: 137–162.CrossRefGoogle Scholar
  30. 30.
    Brewster BS, Strong PN. Naturally occuring potassium channel blockers in western AG, Hamilten TG eds.Potassium channel modulator. 1992; 272–303.Google Scholar
  31. 31.
    Sofer S. Scorpion envenomation.Int Care Med 1995; 21: 626–628.CrossRefGoogle Scholar
  32. 32.
    Kumar EB, Soomro RS, Handani AA, Shimy NE. Scorpion venom cardiomyopathy.Am Heart J 1992; 123: 725–729.PubMedCrossRefGoogle Scholar
  33. 33.
    Yarom R. Scorpion venom: a tutorial review of its effects in men and experimental animals.Clin Toxicol 1970; 3: 561–569.PubMedGoogle Scholar
  34. 34.
    Gueron M, Yarom K. Cardiovascular manifestations of severe scorpion sting.Chest 1970; 57: 156–162.PubMedCrossRefGoogle Scholar
  35. 35.
    Bawaskar HS, Bawaskar PH. Cardiovascular manifestation of severe scorpion sting in children: Review of 34 children.Ann Trop Pediatr 1991; 11: 381–387.Google Scholar
  36. 36.
    Gueron M, Ovshcher I. What is the treatment of cardiovascular manifestations of scorpion envenomation?Toxicon 1987; 25 125–130.CrossRefGoogle Scholar
  37. 37.
    Bawaskar HS, Bawaskar PH. Role of atropine in management of cardiovascular manifestations of scorpion envenoming in humans.J Trop Med Hyg 1992; 95: 30–35.PubMedGoogle Scholar
  38. 38.
    Karnad DR, Deo AM, Apte N, Lohe AS. Captopril for correcting diuretic induced hypotension in pulmonary oedema after scorpion sting.Brit Med J 1989; 298: 1430–1431.PubMedCrossRefGoogle Scholar
  39. 39.
    Bawaskar HS, Bawaskar PH. Vasodilators: Scorpion envenoming and the heart.Toxicon 1994; 32: 1031–1040.PubMedCrossRefGoogle Scholar
  40. 40.
    Raab W. Key position of catecholamines in functional and degenerative cardiovascular pathology.Am J Cardiol 1960; 5: 571–578.PubMedCrossRefGoogle Scholar
  41. 41.
    Sofer S, Gueron M. Vasodilators and hypertensive encephalopathy following scorpion envenomation in children.Chest 1990; 97: 118–120.PubMedCrossRefGoogle Scholar
  42. 42.
    Frohlich ED, Apatenin C, Chobunianet al. The heart in hypertension.N Eng J Med 1992; 327: 998–1005.CrossRefGoogle Scholar
  43. 43.
    Freieire JS, Underbil LH. Muscarinic receptors subtypephysiology and clinical complications.N Eng J Med 1969; 321: 1022–1028.Google Scholar
  44. 44.
    Cody RJ, Haas GJ, Binkley PFet al. Plasma endothelin correlates with the extent of pulmonary oedema hypertension in patients with chronic congestive heart failure.Circulation 1992; 85: 504–509.PubMedGoogle Scholar
  45. 45.
    Vallance P, Cooler J. Biology and clinical relevance of nitric oxide.Br Med J 1990; 309: 453–457.Google Scholar
  46. 46.
    Lee JC, Spoonenburg DP. Role of alpha adrenoceptors in norepinephrine induced cardiomyopathy.Am J Pathology 1985; 121 316–317.Google Scholar
  47. 47.
    Siman SM, Downing SE. Coronary vasoconstriction and catecholamine cardiomyopathy.Am Heart J 1985; 109: 297–304.CrossRefGoogle Scholar
  48. 48.
    Kurien VA, Oliver LMF. A metabolic cause of arrhythmias during myocardial hypoxia.Lancet 1994; 242: 155–128.Google Scholar
  49. 49.
    Oliver MF, Opie LH. Effects of glucose and fatty acid on myocardial ischemia and arrythmias.Lancet 1994; 343: 155–158.PubMedCrossRefGoogle Scholar
  50. 50.
    Murthy KRK. Insulin reversal haemodynamic changes and pulmonary oedema in children stung by the Indian red scorpionMesobuthus tamulus conanesce pocock.Ann Trop Med Parasitcal 1991; 85: 651–657.Google Scholar
  51. 51.
    Medical research council. Clinical trial of potassium, glucose, insulin (PGI) Treatment in myocardial infarction.Lancet 1968; 11: 1055–1060.Google Scholar
  52. 52.
    Cubeddu LX. New alpha-1 adrenergic receptor antagonists for the treatment of hypertension role of vascular alpha receptors in the control of peripheral resistance.Am Heart J 1988; 116: 133–162.PubMedCrossRefGoogle Scholar
  53. 53.
    Garrison JC, Peach NJ, Kall SW, Nies AS, Taylor P eds.Renin and angiotensin in the pharmacological basis of therapeutics. 8th edn. PP 749–763. Gilman AG, New York Pergaman press 1990.Google Scholar
  54. 54.
    Ismail M. The scorpion envenoming syndrome.Toxicon 1995; 33: 825–858.PubMedCrossRefGoogle Scholar
  55. 55.
    Gueron M, Margulis G, Ilia R, Sofer S. The management of scorpion envenomation.Toxicon 1993; 31: 1071–1076.PubMedCrossRefGoogle Scholar
  56. 56.
    Bawaskar HS, Bawaskar PH. Treatment of cardiovascular manifestation sof human scorpion envenoming. Is serotherapy essential?J Trop Med Hyg 1991; 94: 156–158.PubMedGoogle Scholar
  57. 57.
    Ismail M. Serotherapy of the scorpion envenoming syndrome is irrationally convicted without trial.Toxicon 1993; 31: 1077–1083.CrossRefGoogle Scholar
  58. 58.
    Ismail M. The treatment of the scorpion envenoming syndrome. The Saudi experience with serotherapy.Toxicon 1994; 32: 1019–1026.PubMedCrossRefGoogle Scholar

Copyright information

© Department of Pediatrics All India Institute of Medical Science 1998

Authors and Affiliations

  • H. S. Bawaskar
    • 1
  • P. H. Bawaskar
    • 1
  1. 1.Bawaskar Hospital and Research CentreMaharashtra

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