SCORPION STING- MANAGEMENT

The management is mainly focused on

controlling :Autonomic dysfunction

Pain

Fluid management

Pulmonary edema

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.

Available as scored 1mg tablet. Recommended dose-

30microgram/kg/doseWatch out for “first dose phenomenon”.Given irrespective of BP provided there is no hypovolemia.Blood pressure should be monitored.

Pain:Benzodiazepines are given to quieten a child restless after a scorpion sting.If severe pain : NSAIDSLocal ice packs, xylocaine, dehydroemetine (counter irritant), streptomycin (NM blockade)

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.

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.

AVOID MORPHINE.

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.Better to administer prazosin.

Unhelpful treatment:Lytic cocktail

(Pethidine+Promethazine+Chlorpromazine)MorphineSteroidsAtropineNifidepineACE inhibitors

REFERENCE:www.indianpediatrics.net