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Serotherapy

Treatment of cardiovascular manifestations of human scorpion envenoming: Is serotherapy essential?
Introduction

Scorpion sting occurs almost exclusively in the tropics and frequently in rural India. Deaths from acute pulmonary oedema have been reported from this region (Mundle 1961, Bawaskar 1977, Gaitonde et al. 1978). The red scorpion (Mesobuthus tamulus, formerly Buthus or Buthotus tamulus) is found in the coastal region of India.

Its venom is a potent autonomic stimulator resulting in sudden liberation of endogenous catecholamines into the circulation (Bawaskar 1982, Gueron & Weizman 1969). The haemodynamic and myocardial consequences of scorpion venom have been reported in experimental as well as a human envenoming (Gueron & Ovsyshcher 1987, Sofer & Gueron 1988). Hypertension, bradycardia, tachycardia, pulmonary oedema and hypotension resulting from scorpion envenoming have been reported (Bawaskar & Bawaskar 1989).

Summary
Death due to sting by the red scorpion is not uncommon in parts of India. Extensive clinical study has shown that fatality is due to cardio–vascular involvement as a result of autonomic storm. Prazosin and nifedipine helped to counter the physiological actions of scorpion venom on the sympathetic nervous system. Scorpion antivenom remains unobtainable for human scorpionism in India.

Treatment
Severity of the cardiovascular manifestations depends upon the duration of envenoming, concentration of lethal fractions of venom injected at the time of sting and the time elapsing between the sting and therapeutic intervention with the calcium blocker nifedipine or the postsynaptic alpha blocker prazosin (Ismail & Abd–Elsalam 1988, Bawaskar & Bawaskar 1987, 1988, Sofer & Gueron 1990, Gueron & Sofer 1990).

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