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Cardiac Sarcolemmal Defects in Acute Myocarditis Due to Scorpion Envenoming Syndrome  [PDF]
K. Radha Krishna Murthy
World Journal of Cardiovascular Diseases (WJCD) , 2014, DOI: 10.4236/wjcd.2014.49054
Abstract:

Death due to scorpion envenoming syndrome is a common event in tropical and subtropical countries. Severe scorpion envenoming causes autonomic storm, massive release of catecholamines, counter-regulatory hormones, suppressed insulin/hyperinsulinemia, acute myocarditis, hyperglycemia, increased free fatty Acid levels, acute pancreatitis, disseminated intra-vascular coagulation, acute pulmonary oedema and death. Severe scorpion envenoming causes cardiac sarcolemmal defects displayed by alterations in Na+ - K+ ATPase, Mg++ ATPase and Ca2+ ATPase activities, inhibition of erythrocyte Na+ - K+ ATPase activities, hyperkalemia and may result in 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 acute myocarditis, the cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming. Administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival. 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. The observation of cardiac sarcolemmal defects and physiological basis of various patho-physiological mechanisms involved in the genesis of scorpion envenoming syndrome and its reversal (in the experimental animals and scorpion sting victims) by administration of insulin are reviewed.

The use of antivenom reverses hematological and osmotic fragility changes of erythrocytes caused by indian red scorpion Mesobuthus tamulus concanesis POCOCK in experimental envenoming
RADHA KRISHNA MURTHY, K.;ABBAS ZARE, M.;
Journal of Venomous Animals and Toxins , 2001, DOI: 10.1590/S0104-79302001000100008
Abstract: acute myocarditis was induced in experimental dogs by subcutaneous (sc) injection of 3mg/kg of scorpion venom from mesobuthus tamulus concanesis pocock (earlier called buthus tamulus). an increase in hemoglobin (hb), mean corpuscular hemoglobin concentration (mchc), packed cell volume (pcv), plasma hemoglobin (plasma hb) levels, and increased osmotic fragility of erythrocytes in vivo was observed after envenoming. an increase in osmotic fragility of red blood cells (rbc) was also observed when the blood in vitro was incubated with different concentrations of scorpion venom. species- specific scorpion antivenom (sav) was administered to different groups of animals at different time intervals following scorpion envenoming. this resulted in a decrease in hb, mchc, pcv, and plasma hb levels in the envenomed animals and reversal of osmotic fragility changes of erythrocytes. it has been suggested that scorpion venom causes an autonomic storm releasing massive amounts of counter-regulatory hormones, such as catecholamines, angiotensin-ii, glucagon, cortisol, and changes in insulin secretion resulting in hematological and osmotic fragility changes of erythrocytes. administration of sav effectively neutralized, prevented, and reversed scorpion venom toxicity and related osmotic fragility changes of erythrocytes.
The scorpion envenoming syndrome: a different perspective. The physiological basis of the role of insulin in scorpion envenoming
MURTHY, K. R. KRISHNA;
Journal of Venomous Animals and Toxins , 2000, DOI: 10.1590/S0104-79302000000100002
Abstract: death caused by scorpion envenoming (buthidae family) is a common event in tropical and subtropical countries. severe scorpion envenoming causes an autonomic storm resulting in a massive release of catecholamines, angiotensin ii, glucagon, cortisol, and changes in insulin secretion. as a consequence of these changes in the hormonal milieu, scorpion envenoming results in a syndrome of fuel energy deficits and an inability of the vital organs to utilize the existing metabolic substrates, which causes myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary oedema, and many other clinical manifestations alone or in combination, producing multi-system-organ-failure (msof) and death. insulin-glucose infusion or antivenom administration through the release of insulin seems to be the physiological basis for the control of the metabolic response when that has become a determinant to survival of scorpion sting victims.
THE BLOOD LEVELS OF GLUCAGON, CORTISOL, AND INSULIN FOLLOWING THE INJECTION OF VENOM BY THE SCORPION (Mesobuthus tamulus concanesis, POCOCK) IN DOGS
RADHA KRISHNA MURTHY, K.;HAGHNAZARI, L.;
Journal of Venomous Animals and Toxins , 1999, DOI: 10.1590/S0104-79301999000100004
Abstract: severe envenoming was induced in two groups of experimental dogs after subcutaneous (sq) injection of venom of the scorpion (mesobuthus tamulus concanesis, pocock) (3.0 and 3.5 mg/kg body weight). the circulating levels of blood sugar, insulin, glucagon, and cortisol were assayed at 0, and 30, 60, 90 and 120 min after venom injection. there was an increase in the circulating levels of blood sugar, insulin, glucagon, and cortisol following envenoming. scorpion envenoming causes an autonomic storm resulting in a massive release of catecholamines, angiotensin ii, glucagon, and cortisol accompanied by changes in insulin secretion. the rise in the counter-regulatory hormones (glucagon, cortisol, and catecholamines) oppose the anabolic actions of insulin resulting in a variety of clinical manifestations. these changes may lead to a syndrome of fuel-energy deficits and to an inability of the vital organs to utilise the existing metabolic substrates, ultimately resulting in multisystem organ failure (msof) and death.
INSULIN ADMINISTRATION IN SEVERE SCORPION ENVENOMING
YUGANDHAR, B.;RADHA KRISHNA MURTHY, K.;SATTAR, S. A.;
Journal of Venomous Animals and Toxins , 1999, DOI: 10.1590/S0104-79301999000200007
Abstract: the efficacy of insulin-glucose infusion in reversing myocardial damage, haemodynamic changes, peripheral circulatory failure, and pulmonary oedema was evaluated in 25 victims of venomous scorpion stings from the rayalaseema region in the south of india. myocardial damage with peripheral circulatory failure was seen in all scorpion sting victims. ten of these victims also had pulmonary oedema. all the patients received continuous infusion of regular crystalline insulin at the rate of 0.3 u/g of glucose and glucose at the rate of 0.1 g/kg/h with supplementary potassium as needed, inotropic agents, oxygen, as well as maintenance of fluid, electrolytes and acid-base balance. insulin-glucose infusion was associated with reversal of cardiovascular and haemodynamic changes, and pulmonary oedema in 24 of the 25 victims. one severely envenomed victim admitted 72 hours after the sting died. the scorpion envenoming syndrome with myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary oedema, and many other clinical manifestations may cause multi-system organ failure (msof). it is characterised by a massive release of catecholamines, angiotensin ii, glucagon, cortisol, and inhibition of insulin secretion. under these altered conditions in the hormonal milieu, 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. administration of insulin-glucose infusion to scorpion sting victims appears to be the physiological basis for the control of the metabolic response when that has become a determinant to survival.
Investigations on the role of insulin and scorpion antivenom in scorpion envenoming syndrome
Radha Krishna Murthy, K.;As, Dubey;Zare Abbas, M.;Haghnazari, L.;
Journal of Venomous Animals and Toxins including Tropical Diseases , 2003, DOI: 10.1590/S1678-91992003000200006
Abstract: acute myocardiopathy in alloxan treated experimental dogs and rabbits was induced by subcutaneous (sq) injection of scorpion venom from mesobuthus tamulus concanesis, pocock. envenoming resulted in an initial transient hypertension (180-320 mm hg.) followed by hypotension. simultaneous administration of venom and species-specific scorpion antivenom (sav) prevented hypertension and hypotension. hypotension did not occur when sav was given 60 min after envenoming. blood glucose, triglycerides, cholesterol, amylase, insulin, glucagon, cortisol, hematocrit, mean corpuscular volume (mcv), mean corpuscular hemoglobin (mch), mean corpuscular hemoglobin concentration (mchc), platelet count, red blood cell (rbc) count, hemoglobin (hb), 2,3-diphosphoglycerate (2,3-dpg), and glutathione levels were increased 60 and 90 min after envenoming. total white blood cell (wbc) count was reduced 60 min and increased 90 min after envenoming. simultaneous administration of venom and sav did not alter hb, mchc, and packed cell volume (pcv) levels, or ecg, and cardiovascular, biochemical, metabolic, and hormonal changes. hematological parameters were reversed when sav was given 30 and 60 min after envenoming. pcv, hb, and mchc values returned to normal 120 min after sav. alloxan-treated dogs showed increased blood glucose, cholesterol, glucagon, cortisol levels; reduced glycogen content of liver, cardiac and skeletal muscles; and reduced insulin levels and insulin/ glucagon ratio (i/g ratio). envenoming in the alloxan pre-treated dogs further increased these levels and reduced tissue glycogen content, insulin levels, and i/g ratio. administration of 4 u of insulin to alloxan pre-treated envenomed rabbits caused a biochemical and clinical improvement and increased glycogen content of all tissues in comparison with the values from those administered with sav to alloxan pre-treated envenomed animals. sav administration to envenomed alloxan pre-treated rabbits did not cause clinical or biochemi
Scorpion bite and multiple cerebral infarcts.
Thacker A,Lal R,Misra M
Neurology India , 2002,
Abstract: Multiple cerebral infarcts, bilateral optic neuropathy with limb ischemia, following scorpion bite is documented. Vasospasm and autonomic storm due to envenomation is a plausible explanation for this symptom complex.
Transient Myocarditis and Cardiomyopathy After Scorpion and Spider Envenomation  [cached]
Mustafa K?r,Ula? Karada?,Nuh Y?lmaz,Gül Sa??n Saylam
Güncel Pediatri , 2011,
Abstract: Introduction: Spider and scorpion stings can cause multiple clinical manifestations such as local skin reactions or multiple organ failure that can cause death. Multi-organ involvement is more frequent in children due to their lower body weight. The most important life threatening event after the sting is cardiac and lung involvement. In this case report, two cases who developed myocarditis and cardiomyopathy following scorpion and spider stings were reported.Case Report: Clinical evaluation of a ten-year-old boy with respiratory distress and tachycardia after being bitten by a spider on his right hand revealed high levels of cardiac enzymes [CK-MB: 16.5 ng/ml (N:0.0-7.2 ng/ml), troponin: 3.06 ng/ml (N:0.0-0.3ng/ml)], pathological ST elevations in leads V3 and V4, and T wave negativity in leads V5 and V6. In echocardiography, left ventricular dilatation and moderate systolic dysfunction were found. Antivenom [Serum antiscorpionique (labs 50)] was given (5 cc antivenom was administered intravenously following a 1:10 dilution with normal saline). With supportive treatment, all pathological findings resolved in a week. The second case was an eight-year-old boy who had been bitten by a scorpion on his foot and taken to the intensive care unit because of respiratory distress and convulsion. Two doses of antivenom were given to the case who had elevated levels of troponin and CK-MB, pathological ST depressions in ECG, and left ventricular dilatation and systolic dysfunction, as revealed by echocardiography. With dobutamin and supportive treatment, the pathological findings normalized in ten days.Conclusion: Myocarditis developing following spider or scorpion bites can threaten life due to left ventricular systolic dysfunction. This consequence has been attributed to increased catecholaminergic activity or direct effect of toxin to myocardial fibres. ECG must be performed, cardiac enzymes must be monitored and echocardiography must be done to evaluate cardiac involvement in cases suffering from such bites. Severe cases must be taken to the intensive care unit in order to monitor respiratory and circulatory systems. (Journal of Current Pediatrics 2011; 9: 100-2)
THE MOUSE AS AN EXPERIMENTAL MODEL FOR TITYUS SERRULATUS SCORPION ENVENOMING
Magalh?es, M?nica de M?nico;Viana, Gisele;Arantes, Rosa Maria Esteves;Santos, Tasso Moraes;Cunha-Melo, José Renan;
Acta Cirurgica Brasileira , 1994, DOI: 10.1590/S0102-86501998000400011
Abstract: the scorpion toxin induces a number of physiological parameters alterations, as disturbance of cardiac rhythm, heart failure, shock, pancreatic hypersecretion, abortion, respiratory arrhytmias and pulmonary edema. as the purification of the venom fractions is a laborious process, one alternative for this would be the utilization of small animals. we utilized in the present study thity-six mice that received progressive doses of scorpion toxin tstx), i.p. or i.v., and were observed for three hours or sacrificed, and the pulmonary alterations were determined by the lung-body index and by histological analysis of the lungs in order to determine if the mouse can be an esperimental model for scorpion envenomation. the data were analyzed by one way analysis of variance with p<0,05 indicating significance. these experiments showed no differences in clinical signs of scorpion envenomation between mice and other mammalians, the effects were dose-dependent and the i.v. administration needed less quantity to produce the same changings. in the pulmonary histology we observed septal but not alveolar edema, and we presumed that these differences are due to species-specific variations.
THE MOUSE AS AN EXPERIMENTAL MODEL FOR TITYUS SERRULATUS SCORPION ENVENOMING  [cached]
Magalh?es M?nica de M?nico,Viana Gisele,Arantes Rosa Maria Esteves,Santos Tasso Moraes
Acta Cirurgica Brasileira , 1998,
Abstract: The scorpion toxin induces a number of physiological parameters alterations, as disturbance of cardiac rhythm, heart failure, shock, pancreatic hypersecretion, abortion, respiratory arrhytmias and pulmonary edema. As the purification of the venom fractions is a laborious process, one alternative for this would be the utilization of small animals. We utilized in the present study thity-six mice that received progressive doses of scorpion toxin TsTX), i.p. or i.v., and were observed for three hours or sacrificed, and the pulmonary alterations were determined by the lung-body index and by histological analysis of the lungs in order to determine if the mouse can be an esperimental model for scorpion envenomation. The data were analyzed by One Way analysis of variance with p<0,05 indicating significance. These experiments showed no differences in clinical signs of scorpion envenomation between mice and other mammalians, the effects were dose-dependent and the i.v. administration needed less quantity to produce the same changings. In the pulmonary histology we observed septal but not alveolar edema, and we presumed that these differences are due to species-specific variations.
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