Management of Scorpion Sting: Prazosin or Dobutamine

Gupta, Bhavana; Parakh, Manish; Purohit, Abhishek

doi:10.1093/tropej/fmp070

Cited by 23 publications

(19 citation statements)

References 7 publications

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“…If there is an imbalance of fluid and electrolyte or heart failure, treatment should be planned immediately. It has been reported that alpha-adrenergic blockers such as prazosin prevent heart damage related to increased catecholamine in the acute phase (9). This medical treatment improves the clinical findings in majority of patients in similar cases as this study.…”

Section: Discussionsupporting

confidence: 75%

A Case of Acute Myocarditis and Rhabdomyolysis after a Scorpion Sting

Ersoy¹,

Yılmaz²,

Sönmez³

et al. 2017

J Emerg Med Case Rep

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A 30-year-old male farmer presented to our emergency department (ED) with complaints of pain and redness in the bite site approximately 1 h after being stung on his left foot by a scorpion while he was working on his farm in the night. The patient had no chronic diseases, medical drug use, or allergy in his medical history. He was discharged a few hours after his examination, treatment, and follow-up at the observation unit because all the symptoms were relieved after treatment and there were no abnormal values from the laboratory examinations. He was re-admitted to the ED with complaints of widespread body pain, fatigue, and mild shortness of breath approximately 6 h after his discharge. During his physical examination, he was conscious, cooperative, oriented, and also mildly agitated. His vital signs were blood pressure, 180/100 mmHg; heart rate, 130/min; tempera-ABSTRACT Introduction: Scorpion stings continue to be a current public health problem in tropical regions of the world. Local effects are usually seen, but fatal cardiovascular complications may occur, albeit rarely, from scorpion stings. The purpose of this case is to emphasize that rhabdomyolysis and myocarditis can occur in patients admitted to a hospital with a scorpion sting. Case Report: A 30-year-old male patient presented to our emergency department (ED) with complaints of pain and redness in the bite site after being stung by a scorpion. His blood pressure was 180/100 mmHg and heart rate was 130/ min. Electrocardiography (ECG) showed a sinus tachycardia. Laboratory tests revealed the following values: creatinine: 1.71 mg/dL, creatinin kinase (CK): 2129 U/L, creatinin kinase-myocardial band (CK-MB): 43.24 ng/mL, and troponin: 22.59 ng/mL. After catheterization of the bladder, dark brown urine was seen. There were no pathological findings in coronary angiography, but the left ventricular ejection fraction was detected as 45%. The clinically stable patient was discharged on the fifth day of hospitalization. There were no abnormal findings in the latest tests of laboratory parameters. Conclusion: Scorpion stings can cause death due to toxic effects on the cardiovascular system. Observations for possible complications from a scorpion sting, such as the possibility of myocarditis, should be kept in mind in patients admitted to the ED with complaints of a scorpion sting.

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Section: Discussionsupporting

confidence: 75%

A Case of Acute Myocarditis and Rhabdomyolysis after a Scorpion Sting

Ersoy¹,

Yılmaz²,

Sönmez³

et al. 2017

J Emerg Med Case Rep

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“…Gupta et al44 showed that prazosin is slightly better than dobutamine in terms of faster recovery, and also because it is easier to administer. However, this could be due to the particular circumstances or scorpion species involved, given that heart failure is a late complication of scorpion envenoming.…”

Section: Management Of Scorpion Stingsmentioning

confidence: 99%

Emerging options for the management of scorpion stings

Chippaux¹

2012

DDDT

172

132

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Scorpion stings are common in many tropical countries. Although most scorpion stings cause only localized pain without life-threatening envenoming, about one third of stings cause systemic envenoming which can result in death. Children are particularly sensitive to scorpion envenoming. The severity of scorpion stings is related to the presence of neurotoxins in the venom that cause a sudden release of neurotransmitters from the autonomic nervous system, predominantly sympathetic. There is also a strong inflammatory response that worsens symptoms, including those of a respiratory nature. Several vital functions may be directly affected, including the cardiovascular, respiratory, and neuromuscular systems. Hypertension is constant at the beginning of systemic envenoming and sometimes has a severe cardiac and respiratory impact. Although controversial, immunotherapy is the only etiological treatment. Administered early, it prevents many complications and improves the outcome. New antivenoms are highly purified immunoglobulin fragments, the efficacy and safety of which are excellent. As a consequence, adverse reactions to antivenoms are now very rare and usually mild, which should limit any reluctance regarding their routine use. Symptomatic treatment is still necessary to support immunotherapy, especially in cases of delayed arrival at hospital. A combination of both approaches should be considered, based on local resources and constraints.

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“…A different study comparing intravenous dobutamine vs. prazosin ( n = 21, in each treatment arm, all paediatric patients) concluded that recovery was faster (especially for complications such as pulmonary oedema) with prazosin [14]. …”

Section: Resultsmentioning

confidence: 99%

Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials

Rodrigo

Gnanathasan

2017

Syst Rev

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BackgroundScorpion stings cause an estimated 3000 deaths per annum worldwide. We conducted a systematic review of all controlled clinical trials related to scorpion sting management.MethodsWe searched PubMed, EMBASE, Scopus, Web of Science and CINAHL and included controlled prospective clinical trials (randomized or non-randomized). The following interventions were assessed: adults and children with scorpion stings treated with (a) steroids vs. placebo, (b) different methods of pain relief, (c) antivenom vs. supportive treatment, (d) prazosin vs. supportive treatment, (e) antivenom vs. prazosin and (f) antivenom plus prazosin vs. prazosin alone. When trials had comparative outcomes, they were combined in a meta-analysis. Data was analysed with Review Manager 5. Dichotomous data were compared with relative risk (RR), and continuous data were compared with mean differences using a fixed effect model. There is no PROSPERO registration number for this study.ResultsAntivenom against Centruroides sp. are effective in reversing the clinical syndrome faster than no antivenom treatment in children (RR, 0.02; 95% CI, 0.01 to 0.06; 322 participants; three trials). Antivenom (against Mesobuthus tamulus) and prazosin combination is better than prazosin alone for faster resolution of symptoms (mean difference, −12.59 h; 95% CI, −14.01 to −11.17; 173 participants; three trials).ConclusionsThe polyvalent antivenom against Centruroides sp. in USA/Mexico and the monovalent antivenom against M. tamulus in India are effective for rapid resolution of symptoms. Prazosin is useful as an add-on therapy for M. tamulus stings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-017-0469-8) contains supplementary material, which is available to authorized users.

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Management of Scorpion Sting: Prazosin or Dobutamine

Abstract: Prazosin and dobutamine, both are useful drugs for management of cardiovascular features of scorpion envenomation, nevertheless, prazosin is slightly better than dobutamine in terms of faster recovery, and also because of its ease of administration and low cost of therapy.

Cited by 23 publications

References 7 publications

A Case of Acute Myocarditis and Rhabdomyolysis after a Scorpion Sting

A Case of Acute Myocarditis and Rhabdomyolysis after a Scorpion Sting

Emerging options for the management of scorpion stings

Management of scorpion envenoming: a systematic review and meta-analysis of controlled clinical trials

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