Sympathetic nervous system activation, antivenin administration and cardiovascular manifestations of scorpion envenomation

Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a signifi cant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy. These data include electrocardiographic changes, profi ling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging fi ndings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The effi ciency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.

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“…The initial clinical manifestations are mainly due to venominduced cholinergic and adrenergic effects (3) (4) (14) (15) (16) (17) .…”

Section: Systemicmentioning

confidence: 99%

“…Symptoms usually start with more transitory parasympathetic activation. Severity, however, is generally determined by the long-lasting effects of high catecholamine concentrations in the cardiovascular system (4) (15) (16) (17) .…”

Section: Systemicmentioning

confidence: 99%

Clinical update on scorpion envenoming

Cupo

2015

Rev. Soc. Bras. Med. Trop.

125

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“…The patchy and peripheral distribution of lung edema indicates increased vascular permeability. In study of MAZZEI DE DAVILA et al, that was carried out in patients with cardiovascular manifestations of pulmonary edema induced by scorpion envenomation, plasma norepinephrine was elevated in seven of eight patients 29 . Patients have variable degrees of pulmonary edema.…”

Section: Discussionmentioning

confidence: 91%

Asymmetric pulmonary edema after scorpion sting: a case report

Razi

Malekanrad

2008

Rev. Inst. Med. trop. S. Paulo

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SUMMaRYA 12-year-old boy was referred with acute asymmetric pulmonary edema (APE) four-hour after scorpion sting to Emergency department. On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. The patient was treated with oxygen, intravenous frusemide and digoxin and discharged on the sixth hospital day in a good condition. This case report emphasizes the occurrence of asymmetric pulmonary edema after severe scorpion envenomation within few hours immediately after the sting.

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“…pulmonary edema and cardiogenic shock). In a second clinical investigation, we performed two-dimensional echocardiograms and measured norepinephrine serum levels, to simultaneously assess cardiac function and sympathetic activation 3 . Our results demonstrated that, in children with scorpion envenomation, pulmonary edema and cardiogenic shock were accompanied by massive sympathetic activation and variable degrees of reversible left ventricular systolic dysfunction.…”

Section: Introductionmentioning

confidence: 99%