Second Dose of Scorpion Antivenom in Children with Indian Red Scorpion (Mesobuthus tamulus) Sting Envenomation

Abimannane, Anitha; Rameshkumar, Ramachandran; Satheesh, Ponnarmeni; Mahadevan, Subramanian

doi:10.1007/s13312-018-1275-7

Cited by 6 publications

(5 citation statements)

References 7 publications

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“…In general, the existence of myocardial dysfunction and the severity of the envenomation are well correlated with troponin levels making troponin a good screening tool especially [ 34 , 55 ]. Other studies showed that CK-MB is likely to be elevated in most envenomations (even those without cardiac dysfunction), while NT-proBNP and troponin are more specific markers of cardiac dysfunction [ 55 , 57 , 58 , 106 ]. Khalaf et al [ 52 ] found low sensitivity and specificity for CK-MB [ 57 ].…”

Section: Discussionmentioning

confidence: 99%

Scorpion envenomation-associated myocarditis: A systematic review

et al. 2023

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Background Scorpion envenomation is associated with several complications. One of the most serious complications is the cardiac involvement in the form of myocarditis that remains the main reason for mortalities associated with scorpion envenomation. The present review aims to elucidate clinical and paraclinical findings associated with scorpion-related myocarditis, and to explore different management strategies and subsequent outcomes. Methods We searched PubMed, Web of Science, Scopus, and Google Scholar for articles related to keywords of myocarditis associated with scorpion envenomation up to May 1, 2022. Each article was carefully reviewed by two independent researchers. In case of disagreement for inclusion, we sought a third researcher opinion. Results A total of 703 cases from 30 case reports and 34 case series were included in our review. Myocarditis associated with scorpion envenomation was usually reported in children presenting with cardiopulmonary symptoms including pulmonary edema (60.7%) and shock or hypotension (45.8%). The most common ECG findings are sinus tachycardia (82%) followed by ST-T changes (64.6%). The management typically included inotropes (especially dobutamine), prazosin, diuretics, nitroglycerine and digoxin, when indicated. Mechanical ventilation was required in 36.7% of the patients. Mortality in confirmed scorpion-related myocarditis cases is estimated at 7.3%. Almost all survived cases showed rapid recovery and improvement in the left ventricular function. Conclusion Even though myocarditis associated with scorpion envenomation is rare, it remains a serious and in some of cases a fatal consequence of scorpion sting. In case of relative presentations, particularly in envenomed children, diagnosis of myocarditis should be considered. Early screening using serial cardiac markers and echocardiography can guide the treatment. Prompt treatment that focuses on cardiogenic shock and pulmonary edema usually results in a favorable outcome.

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Section: Discussionmentioning

confidence: 99%

Scorpion envenomation-associated myocarditis: A systematic review

et al. 2023

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“…6 The two antivenom ampoules administered here are deemed sufficient to treat severe envenomations 29 ; however, lack of additional antivenom doses precluded further immunotherapy, as recommended previously when worsening to higher degrees of envenomation occurs within 6 hours of the first dose. 30 The severity of this case and the local antivenom shortage demand implementation of appropriate health measures, including adequate supplies of specific antivenoms in remote endemic areas of eastern Ecuador and elsewhere in the Amazon Basin, to reduce the time elapsed between sting and antivenom administration for treatment of envenomed children and pregnant women.…”

Section: Discussionmentioning

confidence: 99%

Case Report: Fatal Scorpion Envenomation in a Shuar Child by Tityus cisandinus from Amazonian Ecuador: A Call for Specific Antivenom Availability in the Amazon Basin

Borges¹,

Román²

2023

The American Journal of Tropical Medicine and Hygiene

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Envenomation by scorpions belonging to the genus Tityus can be life threatening in the Americas, particularly in the Amazon Basin. We report a 4-month-old Ecuadorean boy of Shuar origin stung by a scorpion identified as Tityus cisandinus in the Amazonian province of Morona Santiago, presenting with pulmonary edema and systemic inflammation. We administered immunotherapy using the scorpion antivenom available in Ecuador, of Mexican origin (anti-Centruroides). Catecholamine discharge-related events such as hyperglycemia and thrombocytosis were resolved after treatment but leukocytosis did not, suggesting that factors associated with the sting-admission delay and specificity of antivenom played a role in the envenomation outcome. Cardiorespiratory arrest determined a fatal outcome, despite specific maneuvers. The case severity and the limited supply of nonspecific scorpion antivenoms in problematic areas of Amazonian Ecuador and elsewhere in northwestern Amazonia are discussed in regard to the need for specific therapeutic immunoglobulins in the area and in the Amazon Basin as a whole.

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“…Recently Abimannane et al reported that treatment of children showing autonomic symptoms from Indian red scorpion envenomation that could lead to myocardial infarction required second dose of 30 mg (3 ml) [25]. However, reference was not made to the weight of the children.…”

Section: Treatment Of Scorpion Envenomation Requires Body Weightmentioning

confidence: 99%

“…Therefore, there is need to reassess treatment of Mesobuthus tamulus envenomation in children. The formula developed by Saganuwan [26] [25] indicating that the initial dose of the antivenin should be 30 mg (3 ml) followed by 60 mg (6 ml) of the second dose. The second dose should be 24 mg (2.4 ml).…”

Section: Treatment Of Scorpion Envenomation Requires Body Weightmentioning

confidence: 99%

Toxicosis of Snake, Scorpion, Honeybee, Spider, and Wasp Venoms: Part 2

Saganuwan¹

2021

Medical Toxicology

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Toxicosis is a poisoning caused by venomous animals such as snake, scorpion, honeybee, spider and wasp. Their poisons contain amino acids, peptides, proteins, enzymes and metallic ions that are responsible for neurotoxicity, hemotoxicity and myotoxicity. Because of in vivo therapeutic challenges posed by toxicosis, there is need for ideal therapeutic agents against envenomation caused by venomous animals. Findings have shown that toxicosis could be treated symptomatically. Snake and scorpion antivenins could be used for treatment of poisoning caused by snake, scorpion, honeybee, spider and wasp. The amount of antivenin is dependent on the quantity of venom injected into the affected individuals. Moreso, sympotomatic treatments are also done according to the systems affected. Hospitalization is necessary for assessment of therapeutic success.

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Second Dose of Scorpion Antivenom in Children with Indian Red Scorpion (Mesobuthus tamulus) Sting Envenomation

Abstract: Children with severe scorpion sting envenomation with abnormal echocardiography may require a higher dose of scorpion antivenom.

Cited by 6 publications

References 7 publications

Scorpion envenomation-associated myocarditis: A systematic review

Scorpion envenomation-associated myocarditis: A systematic review

Case Report: Fatal Scorpion Envenomation in a Shuar Child by Tityus cisandinus from Amazonian Ecuador: A Call for Specific Antivenom Availability in the Amazon Basin

Toxicosis of Snake, Scorpion, Honeybee, Spider, and Wasp Venoms: Part 2

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