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Clinical Research in a Rural Setting by Dr. Bawaskar

Red scorpion

The red scorpion (mesobuthus tamulus) is common in rural India, especially in the coastal areas where about 10–12 cases are seen every month in primary health centers. Red scorpion venom contains a potent cardiotoxin which when given to guinea pigs and mice causes pulmonary edema and death. Despite the use of digoxin, diuretics, aminophylline and medical phlebotomy, Dr. P. M. Mundle in 1961 drew attention to high fatality (23/78) due to scorpion–sting. In 1973 Dr. H. S. Bawaskar, MD, a physician, took interest in this problem and did a meticulous study of the clinical and electrocardiographics features of envenomation.

Bibliography

Cardiovascular Manifestations

Clinical Observations

Management of the Cardiovascular Diseases

Scorpion Sting

Scorpion Sting: A Review of 121 cases

Snake Bite

Vasodilations

Barefoot children and farm laborers are at special risk of being stung. Scorpions often live in places sheltered from heat – for example, under tiled roofs and in piles of dry husks. These husks are frequently handled by farmers between October and November, which accounts for the high incidence of stings during this period. There is another peak of scorpion–stings between March and June.

Dr. Bawaskar, while in charge of a primary health center in birwadi, in colaba district of Maharashtra State, studied this problem between August, 1976, and December, 1984. He studied 214 patients (age range 8 to 25 years) with scorpion–sting who presented with pain at the site of sting, sweating, tachycardia, irregular pulse, breathlessness, dilated pupils, occasional vomiting and priapism. Over half the patients, notably the young, had pulmonary edema and five patients died despite rigorous treatment with frusemide, digitalis and atropine.

Pulmonary edema developed in 24/41 patients ant time between 30 minutes to 29 hours of the sting (mean: 11 hours). Pulmonary edema resulted from extensive myocarditis and gross left ventricular failure. Dr. Bawaskar studied the available literature on scorpion–stings.

Scorpion venom is a potent stimulator of the autonomic nervous system. An initial transient cholinergic stimulation (clinically manifested as vomiting, sweating, salivation and bradycardia) is followed by sustained adrenergic hyperactivity (clinically manifested by hypertension, tachycardia, arrhythmia and ECG changes: Left anterior hemiblock, hypoxic ST–T changes and prolonged QRS and QT).

Studies have shown that myocardial damage following scorpion–sting results from calcium ion influx into the heart muscle cells, hence a calcium channel blocker such as nifedipine was a rational choice of treatment. Dr. Bawaskar found sublingual nifedipine very suitable, particularly in severely anxious and agitated children with poor peripheral circulation.

A report by Gueron and Yaron from Israel in 1970 had shown that scorpion venom is a potent sympathetic stimulator resulting in high serum catecholamine levels. Prazosin produces decrease in preload and afterload by alpha receptor blockade.

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