Scorpion sting management

scorpion sting management, prazosin, autonomic dysfunction,pulmonary edema management

1. SCORPION STING- MANAGEMENT

2. The management is mainly focused on controlling :

3. Autonomic dysfunction : PRAZOSIN is given. A competitive post synaptic alpha1 adreno receptor antagonist (controls BP , tachycardia). Suppresses sympathetic outflow and activates venom inhibited potassium channels. Counters vasoconstriction. Cellular and pharmacologic antidote of scorpion venom and is cardio protective.

4. Available as scored 1mg tablet. Recommended dose- 30microgram/kg/dose Watch out for “ first dose phenomenon ”. Given irrespective of BP provided there is no hypovolemia . Blood pressure should be monitored.

5. Pain: Benzodiazepines are given to quieten a child restless after a scorpion sting. If severe pain : NSAIDS Local ice packs, xylocaine , dehydroemetine (counter irritant), streptomycin (NM blockade)

6. Fluid management: Lost because of profuse sweating and vomiting. Encourage to take lots of oral fluids. If the child presents with tachypnoea and altered sensorium: Parenteral fluids(N/5 normal saline) are administered.

7. Pulmonary edema: Mainly due to myocardial dysfunction. Goal is to decrease the afterload without compromising the preload. Dobutamine support (5-15mg/kg/min) with vasodilatation through sodium nitroprusside (0.3-5mg/kg/min) or NTG (5mg/min) infusate is preferred. Prazosin is to be given one hour before termination of Sodium Nitroprusside drip. AVOID MORPHINE.

8. Scorpion antivenom : Usefulness of this venom is yet to be found out. Systemic administration of scorpion antivenin did not alter the clinical course of scorpion sting in a matched pair study undertaken at an Intensive Care Unit in Tunisia. Antivenom against the toxins of Indian scorpions is not available for clinical use. Better to administer prazosin .

9. Unhelpful treatment: Lytic cocktail ( Pethidine+Promethazine+Chlorpromazine ) Morphine Steroids Atropine Nifidepine ACE inhibitors

10. REFERENCE: www.indianpediatrics.net