Scorpion sting management
- 2. The management is mainly focused on controlling : Autonomic dysfunction Pain Fluid management Pulmonary edema
- 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.
- 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.