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LETTER TO EDITOR
Year : 2020  |  Volume : 9  |  Issue : 8  |  Page : 4480  

Uncommon presentation of scorpion sting at teaching hospital


Department of Pathology, Subdistrict Hospital Mangaon, Dist Raigad, Maharashtra, India

Date of Submission11-Jun-2020
Date of Decision19-Jun-2020
Date of Acceptance20-Jun-2020
Date of Web Publication25-Aug-2020

Correspondence Address:
Dr. Santosh Govind Rathod
Kool Homes Green Valley, Bavdhan Pune, Maharastra - 411 021
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_1149_20

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How to cite this article:
Rathod SG. Uncommon presentation of scorpion sting at teaching hospital. J Family Med Prim Care 2020;9:4480

How to cite this URL:
Rathod SG. Uncommon presentation of scorpion sting at teaching hospital. J Family Med Prim Care [serial online] 2020 [cited 2020 Sep 23];9:4480. Available from: http://www.jfmpc.com/text.asp?2020/9/8/4480/292999



Dear Editor,

We read with great interest article by Pradeep et al.[1] in their case, author did not use prazosin in management of sever scorpion sting with pulmonary edema. Scorpion venom includes mixture of low molecular weight peptide toxin, which targets the ion channel. Alfa toxin inhibits the inactivation of neuronal sodium channels and resulting in a sustained depolarization and neuronal excitation. As results of this, there is autonomic storm in the body leading to pouring of endogenous catecholamines (epinephrine and norepinephrin), Neuropeptide –Y and endothelin-1.[2] In severe scorpion sting, sustained Alfa receptor stimulation results in development of pulmonary edema, in addition to catecholamine-induced myocarditis and myocardial ischemia due to Neuropeptide –Y.[2] Epithelial sodium channels, cystic fibrosis transmembrane conductor, and Na/K-ATPase clear the lung edema. Scorpion venom inhibits alveolar fluid clearance through Endothelin-1. As it impairs the fluid clearance in alveoli.[3] This results in development of pulmonary edema. Prazosin is pharmacological antidote of scorpion envenomation. Prazosin inhibiting phospodiestrase, result in cellular accumulation of cyclic GMP-an endothelin inhibitor, clears pulmonary edema, and corrects the hemodynamic and metabolic effects of envenomation.[2] Prazosin reduces preload and increases the left ventricle compliance.[2] Thus in severe case of scorpion envenomation, use of prazosin and dobutamine will reduce overall morality and recovery time.[4] Noradrenalin will worsen the situation as its predominant Alfa -1 agonist action. Poisonous species of scorpions are present all over India. Monospecific scorpion Antivenom should be made available, at all places where scorpion venomation is common. Recently, in scientific trials, it has confirmed that simultaneous use of prazosin and ant scorpion venom use reduces the cardiovascular mortality and morbidity and prevent Extra load of these cases to intensive care unit, which is beyond the reach of poor people.[5]

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  References Top

1.
Pradeep YK, Bhogaraju VK, Pathania M, Rathur VK, Kant R. Uncommon presentation of scorpion sting at teaching hospital. J Family Med Prim Care 2020;9:2562-5.  Back to cited text no. 1
  [Full text]  
2.
Isbister GK, Bawaskar HS. Scorpion envenomation. N Engl J Med 2014;371:457-63.  Back to cited text no. 2
    
3.
Comellas AP, Brivia A, Dada LA, Butti ML, Trejo HE, Yshii C, et al. Endothelin -1 impairs alveolar epithelial function via endothelial ETB receptor. Am J Respir Crit Care Med 2009;179:113-22.  Back to cited text no. 3
    
4.
Patil SN. A retrospective analysis of a rural set up experience with special reference to dobutamine in prazosin resistant scorpion sting cases. J Assoc Physicians India 2009;57:301-4.  Back to cited text no. 4
    
5.
Bawaskar HS, Bawaskar PH. Effficacy and safety of scorpion Antivenom plus prazocin compared with prazocin alone for venomous scorpion (Mesobuthas Tamulus) sting: Randomised open lable clinical trial. BMJ 2011;342:C7136. doi: 10.1136/bmj.c7136.  Back to cited text no. 5
    




 

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