ABSTRACT
Death due to poisonous scorpion (Buthidae family) stings is a common event in the developing countries. Scorpion envenoming syndrome results in autonomic storm, release of catecholamines, angiotensin II, glucagon, glucocorticoids, either suppressed insulin secretion or hyperinsulinemia; hyperglycemia, lipolysis – sudden increase in free fatty acids (FFA), acute myocarditis, disseminated intravascular coagulation, cardiovascular disturbances, pulmonary oedema, acute pancreatitis, and many clinical manifestations. Under these altered hormonal mileu, insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming in the experimental animals and in scorpion sting victims. Insulin has a primary metabolic role in preventing, counter-acting and reversing the metabolic, cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming and reversing all the deleterious effects of FFA by inhibiting the catecholamine induced lipolysis, and increase intra-cellular K+, facilitating glucose transport to the myocardium and glucose metabolism through different pathways. Profuse sweating, excessive salivation and abdominal pain are the triad of symptoms of ominous significance in scorpion sting victims with acute pancreatitis. Laryngeal spasm and respiratory failure are more common with acute pancreatitis. Continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48–72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance.
ABSTRACT
Death due to scorpion envenoming syndrome is a common event all over the world in tropical and sub-tropical countries. Scorpion envenoming syndrome results in a severe autonomic storm with a massive release of catecholamines, increased levels of angiotensin II, glucagon, cortisol, thyroid hormones, either hypoinsulinemia or hyperinsulinemia, hyperglycemia and increased free fatty acid levels. Under these conditions, scorpion envenoming syndrome with laryngeal spasm, fasciculations, clonus and tetany like skeletal muscle contractions, myocardial damage, disseminated intravascular coagulation, cardiovascular disturbances, peripheral circulatory failure, cardiac pulmonary oedema, adult respiratory distress syndrome, and many other clinical manifestations cause multi-systemorgan-failure and death. Under these altered conditions, scorpion envenoming essentially results in a syndrome of fuel – energy deficits and an inability to use the existing metabolic substrates by vital organs causing MSOF and death. Based on our animal experiments in which insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming and treating the poisonous scorpion sting victims with insulin, we consider that insulin has a primary metabolic role in preventing and reversing laryngeal spasm, fasciculations, clonus and tetany like contractions, the cardiovascular, neurological manifestations and pulmonary oedema. Administration of insulinglucose infusion to scorpion sting victims is the physiological basis for the control of the metabolic response when that has become a determinant to survival. Continuous infusion of regular crystalline insulin at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48–72 hours, potassium supplementation and maintenance of fluid, electrolytes and acid–base balance.