Incidence, mechanisms and impact outcome of hyperglycaemia in severe scorpion-envenomed patients

Abstract

Hyperglycaemia is often observed in severe scorpion-envenomed patients. It is due to a severe autonomic storm with a massive release of catecholamines, increased glucagon levels, cortisol levels, and either decreased insulin levels or insulin resistance. The presence of hyperglycaemia is an indicator of severity in this specific condition. Indeed, hyperglycaemia was associated with the severity of clinical manifestations of severe scorpion envenomation requiring intensive care unit (ICU) admission. In fact, the presence of hyperglycaemia was associated with the presence of respiratory failure, pulmonary oedema, haemodynamic instability, neurological failure, multisystem organ failure, and an increased mortality and ICU length of stay. As a consequence, we think the presence of hyperglycaemia in scorpionenvenomed patients at the emergency department prompts searching for presence of systemic manifestations or cardiorespiratory manifestations. As a consequence, the presence of hyperglycaemia can help screen severe patients at the emergency department. The current management of severe scorpion envenomation involves the admission and close surveillance in the ICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The use of antivenom for scorpion stings remains controversial. All patients with pulmonary oedema should receive prazosin and possibly dobutamine, according the scorpion's species. Mechanical ventilation is usually used in severe cases. Insulin should be reserved for severe cases with confirmed excessive hyperglycaemia (>10 mmol/l).

Scorpion Stings in Tehran Province, Iran: A Seven-Year Hospital-Based Study

“…Hyperglycemia is another laboratory finding in our study. Previous studies suggested that the presence of hyperglycemia is an indicator of the severity of scorpion stings and was associated with the severity of clinical manifestations, including respiratory failure, pulmonary edema, hemodynamic instability, neurological failure, and multisystem organ failure, which requires intensive care unit (ICU) admission [19]. Scorpionism induces an autonomic disturbance by releasing catecholamines and increased angiotensin II, glucagon, cortisol, and thyroid hormones.…”

“…Scorpionism induces an autonomic disturbance by releasing catecholamines and increased angiotensin II, glucagon, cortisol, and thyroid hormones. Suppression of insulin levels or induction of insulin resistance as a consequence of hyperinsulinemia and increased circulating free fatty acid levels have been shown as mechanisms of hyperglycemia in scorpionism [19,20]. Bouaziz et al found that the laboratory indicators such as leukocytosis of more than 25000 cells/mm3 and blood urea level above 8 mmol/L were correlated with a poor outcome in scorpion stings [21].…”

La importancia médica del escorpionismo en Paraguay: revisión de la falla multisistémica asociada al envenenamiento y contribución a su diagnóstico diferencial

“…Parag. set 2022;27(2):122-152 periférica son eventos asociados al mal pronóstico, así como la aparición de vómitos (74,75) .…”

Endocrine and Metabolic Manifestations of Snakebite Envenoming

“…Scorpion envenoming results in an autonomic storm with massive catecholamine release and increases in glucagon and cortisol levels. 61 The counterregulatory hormones oppose anabolic actions of insulin, leading to hyperglycemia. Catecholamine excess is known to have deleterious effects on glucose and insulin homeostasis.…”