Review of scorpion envenomation
Asian forest scorpion
3 out of 5 stars
Scorpion Envenomation. Isbister GK, Bawaskar HS. N Engl J Med 2014 Jul 31;371:457-463.
Reference
With over 1700 species of scorpions found all over the world, this brief review article is much too short and unfocused to provide more than a superficial overview of its topic.
The authors point out that most scorpion stings cause, at most, minor toxicity with pain and other local effects only. Most serious envenomations are associated with the Buthidae family, which include the genus Centruroides, several of which are found in North America and commonly cause neuromuscular excitation.
Major toxicity is associated with α-toxins, which inhibit deactivation of voltage-gated sodium channels causing sympathetic and parasympathetic autonomic excitation, as well as the release of catecholamines epinephrine and norepinephrine. This can result in:
hypertension
myocardial injury
cardiogenic shock
impaired left ventricular function
hypotension
cardiac conduction abnormalities
pulmonary edema
Features of the sympathomimetic or cholinergic toxidromes can be prominent.
Use of antivenom in cases of scorpion stings is controversial, and this article really doesn’t provide much enlightenment regarding the pros and cons. The authors do note that although antivenom would seem to be more useful in cases of clinically severe envenomation, by the time clinical severity is apparent it may be rather late in the game — although antivenom can bind...
Source: The Poison Review - Category: Toxicology Authors: Leon Tags: Medical antivenom centruroides Review scorpion envenomaton Source Type: news
More News: Cardiogenic Shock | Cardiology | Heart | Hypertension | Insect Bites & Stings | Neurology | Pain | Poisoning | Reflex Sympathetic Dystrophy | Toxicology