Insulin Administration in Severe Scorpion Envenoming

Abstract

The efficacy of insulin-glucose infusion in reversing myocardial damage, haemodynamic changes, peripheral circulatory failure, and pulmonary oedema was evaluated in 25 victims of venomous scorpion stings from the Rayalaseema region in the south of India. Myocardial damage with peripheral circulatory failure was seen in all scorpion sting victims. Ten of these victims also had pulmonary oedema. All the patients received continuous infusion of regular crystalline insulin at the rate of 0.3 U/g of glucose and glucose at the rate of 0.1 g/kg/h with supplementary potassium as needed, inotropic agents, oxygen, as well as maintenance of fluid, electrolytes and acid-base balance. Insulin-glucose infusion was associated with reversal of cardiovascular and haemodynamic changes, and pulmonary oedema in 24 of the 25 victims. One severely envenomed victim admitted 72 hours after the sting died. The scorpion envenoming syndrome with myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary oedema, and many other clinical manifestations may cause multi-system organ failure (MSOF). It is characterised by a massive release of catecholamines, angiotensin II, glucagon, cortisol, and inhibition of insulin secretion. Under these altered conditions in the hormonal milieu, scorpion envenoming essentially results in a syndrome of fuel-energy deficits and an inability to use the existing metabolic substrates by vital organs, causing MSOF and death. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival

Effects of Androctonus crassicauda (Olivier, 1807) (Scorpiones: Buthidae) venom on rat metabolism

“…Many studies have emphasized that blood glucose levels increase after envenomation resulting in hyperglycemia in animal models (10,16,22,(27)(28)(29)(30)(31)49) and patients (2,11,12,47). In the present study, hyperglycemia was seen after A. crassicauda venom administration.…”

Scorpion Venoms

“…In addition, several alterations associated with the presentation of lung injury and how congestion, edema, and alveolar hemorrhage are viewed in the histopathological analysis that are important components of the acute respiratory distress syndrome observed in case reports have been reported (Yugandhar et al 1999;Murthy 2000;Rodríguez 2008;Izquierdo and Rodríguez 2012).…”

“…Other events such as the activation of the renin-angiotensin-aldosterone system by stimulation of the sympathetic system may be related to the reduction of effective blood flow due to the passage of intravascular fluid into the interstitium driving the emergence of peripheral circulatory failure that can be seen in the experimental and clinical descriptions of congestion of organs such as the lung, liver, spleen, and kidney (Yugandhar et al 1999;Rodríguez 2008;Izquierdo and Rodríguez 2012). …”

Neural network-based species identification in venom-interacted cases in India

“…If the victim is a child, these features develop rapidly. The only prescribed treatment is administration of Anti-Scorpion Venom (AScV) serum (17,27).…”