The cardiovascular system after scorpion envenomation. A Review

Abstract

Scorpion envenomation is a common medical problem and life hazard in many countries of the world. Scientific investigations have addressed the interrelationship between the stimulatory effects of the venom on the autonomic nervous system and adrenals and the subsequent effects of released transmitters on the cardiovascular system. A number of clinical cardiovascular syndromes may dominate the initial clinical presentation after envenomation: the syndromes usually vary with the age of the victim, the size of the offender and the season. Central nervous system dysfunction is seen in children but rarely observed in adults; if accompanied by severe hypertension the clinical picture is consistent with acute hypertensive encephalopathy. Heart failure, pulmonary edema or a shock-like syndrome has been observed in 25% and hypertension in 30% to 77% of our patients. The electrocardiographic abnormalities recorded in the majority of the patients after envenomation include an "acute myocardial infarction-like pattern." Rhythm disturbances are frequent but conduction abnormalities are rare. Echocardiographic, radionuclide and experimental hemodynamic observations have provided evidence that heart failure and pulmonary edema after envenomation are multifactorial with diminished systolic performance following the initially increased left ventricular contractility and decreased ventricular diastolic compliance. Clinical laboratory data reporting increased catecholamine metabolite excretion and elevated plasma renin and aldosterone are consistent with the stimulatory effects of the venom on the autonomic nervous system. Treatment, including our experience with vasodilators and calcium channel blockers, is reviewed.

Scorpion envenomation and serotherapy in Morocco.

“…16 In Saudi Arabia, higher doses (5-20 ml compared with 0.5-1 ml) reduced the mortality rate from an 4-6.8% to less than 0.05%. 3,7,15 Thus, the ineffectiveness of serotherapy reported by some researchers 18,19,32 could be partially explained by the use of low potency and insufficient doses of antivenom. The use of high potency and adequate doses of antivenom is an important factor to be considered.…”

“…1,3,[13][14][15][16] However, others have questioned the usefulness of antivenom in eliminating cardiovascular manifestations of scorpion stings. [17][18][19] In Morocco, serotherapy has been one of the major therapeutic measures used in te treatment of scorpion envenoming for the last 30 years. 20 However, the choice of the antivenom dose and the administration protocol remain arbitrary.…”

Scorpion Envenomation in Children: Should All Stings Be Given Antivenom?

“…Central nervous system disturbances such as confusion, agitation, seizures, cerebral edema and coma are more common in children. [6][7][8] All cases of scorpion sting should be kept under close observation for at least 12 hours.…”

Notes on gestation periods and litter size in the arenicolous buthid scorpion Leiurus quinquestriatus (Ehrenberg, 1828) (Scorpiones: Buthidae)

“…Leiurus quinquestriatus venom is the most toxic reported among scorpion species (LD50: 0.25 mg/kg), capable of provoking both dysfunction and failure of cardiovascular and respiratory systems (13)(14)(15)(16)(17)(18)(19)(20)(21). Neurotoxic venoms are particularly toxic to infants and young children, due to their weight-dependent effects (14).…”