Scorpion envenoming and the cardiovascular system.
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Adolescent↗
Biomedical subjects
H S Bawaskar
Publications and source records attributed to H S Bawaskar.
Severe envenoming by the Indian red scorpion Mesobuthus tamulus: the use of prazosin therapy.
We describe the clinical course and outcome in 46 victims of severe scorpion envenoming treated with prazosin (P), and compare them with earlier patients treated with conventional therapy (C) (n = 45) and nifepidine (N) (n = 28). The incidence of complicating left ventricular failure was 29% for C, 35% for N and 6.5% for P; that of acute pulmonary oedema was 46% for C, 14% for N and zero for P; mortality was 25% for C, 3.5% for N and zero for P. Although this is a historical study, prazosin appears to significantly reduce morbidity and shorten recovery time. Experience in other countries suggests that antivenom is helpful in controlling many of these problems, but in rural India serotherapy remains largely unavailable, and prazosin is a mainstay of treatment.
Adolescent↗
Vasodilators: scorpion envenoming and the heart (an Indian experience).
Our aim was to assess clinically whether there was any benefit in adding a single dose of sublingual nifedipine (a slow calcium channel blocker) to prazosin in the management of the cardiovascular manifestations of envenoming by the Indian red scorpion (Mesobuthus tamulus). A total of 163 patients stung by this species was admitted to hospital at Mahad between January 1991 and October 1993. Cardiovascular abnormalities were hypertension (59), of whom 42 had bradycardia and 17 had tachycardia; pulmonary oedema (14), of whom eight had hypertension and six hypotension; supraventricular tachycardia (eight), of whom three had hypotension and one died. Of the remaining patients, 78 demonstrated severe excruciating local pain at the site of sting but had no systemic involvement. Nineteen patients with hypertension and tachycardia were given a single dose of sublingual nifedipine plus prazosin on admission, then prazosin alone repeated 6 hourly. Five patients with massive life-threatening pulmonary oedema recovered after being given intravenous sodium nitroprusside. Prazosin alone helped to alleviate cardiovascular manifestations in the remaining 52 victims. One patient was admitted in a deep coma, 12 hr after the sting, and died. Eight victims whose blood pressure had been controlled in hospital by nifedipine plus prazosin developed acute pulmonary oedema necessitating additional doses of prazosin for recovery. Fifty-two victims treated with prazosin alone did not develop pulmonary oedema and the drug appeared to hasten the recovery. In the presence of high blood pressure, tachycardia, a murmur and impending myocardial failure, nifedipine appeared to contribute to cardiopulmonary instability and to augment myocardial oxygen consumption. In this situation calcium channel blockers should probably be avoided.
Adolescent↗
Management of the cardiovascular manifestations of poisoning by the Indian red scorpion (Mesobuthus tamulus).
OBJECTIVE: The efficacy of nifedipine and prazosin in combination or alone in the management of cardiovascular manifestations caused to Mesobuthus tamulus poisoning was investigated. DESIGN: Observation and study. SETTING: Hospital at Mahad, Maharashtra, India. SUBJECTS: 62 patients who had been stung by a red scorpion were admitted from January to December 1990: 18 with hypertension, 15 with supraventricular tachycardia, 11 with pulmonary oedema, and 18 with local pain at the site of sting but no systemic involvement. Two patients with massive life-threatening pulmonary oedema were given intravenous sodium nitroprusside. RESULTS: The combination of nifedipine and prazosin was more successful in preventing myocardial damage in 16 patients with hypertension than was nifedipine alone in two other patients with hypertension. Prazosin alone helped to alleviate the cardiovascular manifestations in eight patients with pulmonary oedema and 15 with supraventricular tachycardia. One patient with pulmonary oedema died and two recovered after they were given intravenous sodium nitroprusside. CONCLUSION: Nifedipine alone did not prevent myocardial damage unless the peripheral action of venom was blocked by prazosin.
Adult↗
Role of atropine in management of cardiovascular manifestations of scorpion envenoming in humans.
We undertook a retrospective analysis of 35 victims of red scorpion (Mesobuthus tamulus) sting, admitted to our hospital in Mahad, Maharashtra State, India. Increase in duration as well as severity of clinical signs, including myocardial injury and poor response to conventional treatment, were observed in 17 victims treated with atropine compared to another 18 victims who were not so treated. We do not advocate routine use of atropine to block transient cholinergic effects of scorpion envenoming.
Adolescent↗
Cardiovascular manifestations of severe scorpion sting in India (review of 34 children).
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 oedema developed in nine, two had tachycardia (110-200/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 oedema 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.
Adolescent↗
Consecutive stings by red scorpions evoke severe cardiovascular manifestations in the first, but not in the second, victim: a clinical observation.
Three pairs of scorpion sting victims ((1) daughter and mother, (2) brother and sister and (3) brother and sister) were admitted. In each pair, both were stung by the same scorpion. A patients from each pair were the first stung (initial sting), B patients the second. All A victims of the three pairs had cardiovascular manifestations: hypertension, with pulmonary oedema; hypotension-bradycardia, pulmonary oedema; and hypertension respectively. B victims from the three pairs suffered no systemic or cardiovascular involvement, only severe excruciating local pain at the sting site. It is concluded that A victims received a large dose of venom, injected by the scorpion virtually evacuating the telson resulting in an 'autonomic storm' and severe cardiovascular involvement.
Adolescent↗
Treatment of cardiovascular manifestations of human scorpion envenoming: is serotherapy essential?
Death due to sting by the red scorpion is not uncommon in parts of India. Extensive clinical study has shown that fatality is due to cardiovascular involvement as a result of autonomic storm. Prazosin and nifedipine helped to counter the physiological actions of scorpion venom on the sympathetic nervous system. Scorpion antivenom remains unobtainable for human scorpionism in India.
Animals↗
Prazosin for vasodilator treatment of acute pulmonary oedema due to scorpion sting.
Prazosin hydrochloride, a post-synaptic alpha receptor blocking agent, was administered to twelve patients with acute pulmonary oedema due to scorpion sting in order to lower their mean blood pressure (diastolic blood pressure plus one-third of pulse pressure) 10 to 20 mmHg. Following an oral dose (0.125 mg in children and 0.5 mg in adults), clinical improvement was seen in the form of disappearance of apical systolic murmur and pulmonary oedema, a reduction in heart rate observed at the end of the first hour, and maximal improvement seen at the end of the third hour. Chest radiographs showed conspicuous clearing of pulmonary oedema. Electrocardiographs (ECG) showed hypoxic injury patterns such as a Q-wave in lead I and AVL with tented T waves in precordial leads, left anterior hemiblock (LAHB) and acute infarction patterns with subsequent T-wave inversion. The severity of clinical signs and ECG changes increased as the time between the sting and attending hospital lengthened.
Acute Disease↗
Prazosin in management of cardiovascular manifestations of scorpion sting.
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Adolescent↗
Diagnostic cardiac premonitory signs and symptoms of red scorpion sting.
The symptoms and signs of 51 patients with a history of scorpion sting were studied. Acute pulmonary oedema with peripheral circulatory failure due to myocarditis developed in 10. Pulmonary oedema appeared within thirty minutes to ten hours after the sting. 5 out of 7 male patients in whom pulmonary oedema subsequently developed presented with priapism. Profuse sweating, mydriasis, vomiting, and peripheral circulatory failure were also seen, and, in 1 patient, the clinical picture was suggestive on pancreatitis. The remaining 40 patients has severe local pain only and no subsequent cardiac manifestations. There appears to be a positive correlation between occurrence of priapism in a male and the later development of cardiac manifestations after a scorpion sting.
Acute Disease↗
Stings by red scorpions (Buthotus tamulus) in Maharashtra State, India: a clinical study.
Of 33 cases of scorpion sting admitted to hospital in Mahad, Maharashtra State, India, 10 had a mean blood pressure between 100 and 137 mm/Hg and 11 had a heart rate between 130 and 215 per min. Seven patients developed acute pulmonary oedema; there were 2 deaths. Three patients had local pain at the site of sting. The role of vasodilators such as prazosin hydrochloride, sodium nitroprusside and nifedipine were investigated in addition to digoxin, diuretics and aminophylline to alleviate refractory myocardial failure due to scorpion sting.
Adolescent↗
Treatment of envenoming by Mesobuthus tamulus (Indian red scorpion).
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Animals↗
Scorpion sting and cardiovascular complications.
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Cardiovascular Diseases↗