Acute Pancreatitis in Scorpion Envenoming Syndrome: Insulin- Glucose Administration Reverses Haemodynamic Changes, Pulmonary Edema and Other Clinical Manifestations Due to Scorpion (Mesobuthus tamulus Concanesis, Pocock [Buthidae family]) Stings

Radha Krishna Murthy K, Prabhakara Rao R

Abstract


Death due to poisonous scorpion (Buthidae family) stings is a common event in the developing countries. Scorpion envenoming syndrome results in autonomic storm, release of catecholamines, angiotensin II, glucagon, glucocorticoids, either suppressed insulin secretion or hyperinsulinemia; hyperglycemia, lipolysis – sudden increase in free fatty acids (FFA), acute myocarditis, disseminated intravascular coagulation, cardiovascular disturbances, pulmonary oedema, acute pancreatitis, and many clinical manifestations. Under these altered hormonal mileu, insulin administration reversed the metabolic and ECG changes induced by scorpion envenoming in the experimental animals and in scorpion sting victims. Insulin has a primary metabolic role in preventing, counter-acting and reversing the metabolic, cardiovascular, haemodynamic, and neurological manifestations and pulmonary oedema induced by scorpion envenoming and reversing all the deleterious effects of FFA by inhibiting the catecholamine induced lipolysis, and increase intra-cellular K+, facilitating glucose transport to the myocardium and glucose metabolism through different pathways. Profuse sweating, excessive salivation and abdominal pain are the triad of symptoms of ominous significance in scorpion sting victims with acute pancreatitis. Laryngeal spasm and respiratory failure are more common with acute pancreatitis. Continuous infusion of regular crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose at the rate of 0.1 g/kg body weight/hour, for 48–72 hours, with supplementation of potassium as needed and maintenance of fluid, electrolytes and acid-base balance.


Full Text:

PDF

References


Radha Krishna Murthy K. Enzymes and toxins in scorpions of Buthidae family. Insulin-glucose administration reverses metabolic, cardiovascular, ECG changes and pulmonary edema in scorpion envenoming syndrome. Int J Med Biosci (2014). 3(1): 9–25. www.ijmbonline.com

Radha Krishna Murthy K. Haematological changes in acute myocarditis due to scorpion envenoming syndrome. International J Chem Life Sci (2014). 3: 111–26. ISSN: 2234-8638, www.ijcls.com

Radha Krishna Murthy K, Ravi Babu P. Laryngeal spasm in scorpion envenoming syndrome. IJO MDAS (2014). 2(1): 41–8.

Radha Krishna Murthy K. Hypertension, Autonomic storm, increased counter regulatory hormones and suppressed insulin acute myocarditis in scorpion envenoming syndrome. World J Cardiovasc Dis (2014). 4(4): 189–210. Published Online April 2014 in SciRes. http://www.scirp.org/journal/wjcd, http:// dx.doi.org/10.4236/wjcd.2014.44027

Bartholomew C. Acute scorpion pancreatitis in Trinidad. Brit Med J (1970). 1(5697): 666–68.

Reddy B, Suvarnakumari G. Fatal cases of scorpion sting. Autopsy study of 7 cases. Clinician (1972). 36: 94–96.

Balasubramaniam P, Kari RK. Abnormal cardiovascular and electrocardiographic profile and cardiac glycogen content in rabbits injected with scorpion venom. Indian J Physiol Pharmacol (1981). 25(4): 351–55.

Balasubramaniam P, Murthy KRK. Liver glycogen depletion in acute myocarditis produced by scorpion (Buthus tamulus) venom. Indian Heart J (1984). 36(2): 101–104.

Sofer S, Cohen R, Shapir Y, Chen L, Colon A, Scharf S. Scorpion venom leads to gastrointestinal ischemia despite increased oxygen delivery in pigs. Crit Care Med (1997). 25(5): 834–40.

Bucaretchi F, Baracat CF, Nogueira JN, Chaves A, Zambrone FAD, Fonseca RCC, Tourinho S. A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus. Rev Inst Med Trop (Sao Paulo) (1995). 37(4): 331–36.

Handrgal NH, Malleraja Gouda K, Ramnath T. A clinical study of one hundred cases of scorpion sting. J Assoc Physicians India (1989). 34: 37.

Hering SE, Jurca M, Vichi FL, Azevedo-Marques MM, Cupo P. Reversible cardiomyopathy, in patients with severe scorpion envenoming by Tityus serrulatus: evolution of enzymatic, electrocadiographic and echocardiographic alterations. Ann Trop Paediatr (1993). 13(2): 173–82.

Radha Krishna Murthy K. Investigations of cardiac sarcolemmal ATPase activity in rabbits with acute myocarditis produced by scorpion (Buthus tamulus) venom. Japanese Heart J (1982). 23(5): 835–42.

Radha Krishna Murthy K, Anita AG. Reduced insulin secretion in acute myocarditis produced by scorpion (Buthus tamulus) venom. Indian Heart J (1986). 38(6): 467–69.

Radha Krishna Murthy K, Haghnazari. Blood levels of glucagon, cortisol and insulin following scorpion (Mesobuthus tamulus concanesis, Pocock) envenoming in dogs. J Venom Anim Toxins (1999). 5: 47–55.

Radha Krishna Murthy K, Dubey AS, Abbas Zare, Haghnazari L. Investigations on the role of insulin and scorpion antivenom in scorpion envenoming syndrome. J Venom Anim Toxins Incl Trop Dis (2003). 9(2): 202–38.

Radha Krishna Murthy K, Hossein Z. Increased osmotic fragility of red cells after incubation at 37ºC for 24 hours in dogs with acute myocarditis produced by scorpion (Buthus tamulus) venom. Indian J Exp Biol (1986). 38: 206–10.

Radha Krishna Murthy K, Hossein Z. Increased osmotic fragility of red cells in dogs with acute myocarditis produced by scorpion (Buthus tamulus) venom. Indian J Physiol Pharmacol (1986). 30(3): 215– 219.

Ismail M. The scorpion envenoming syndrome. Toxicon (1995). 33(7): 825–58.

Radha Krishna Murthy K, Vakil AE. Elevation of plasma angiotensin levels in dogs by Indian red- scorpion (Buthus tamulus) venom and its reversal by administration of insulin and tolazoline. Indian J Med Res (1988). 88: 376–79.

Radha Krishna Murthy K, Medh JD. Increase in serum free fatty acids. phospholipids and reduction in total cholesterol in acute myocarditis produced by scorpion (Buthus tamulus) venom. Indian Heart J (1986). 38(5): 369–72.

Radha Krishna Murthy K, Hossein Z, Medh JD, Kudalkar JÁ, Yeolekar ME, Pandit SP, Khopkar M. Dave KN, Billimoria FR. Disseminated intravascular coagulation & disturbances in carbohydrate and fat metabolism in acute myocarditis produced by Indian red scorpion (Buthus tamulus) venom. Indian J Med Res (1988). 87: 318–25.

Radha Krishna Murthy K, Medh JD, Dave BN, Vakil YE, Billimoria FR. Acute pancreatitis and reduction of H+ ion concentration in gastric secretions in experimental acute myocarditis produced by Indian red scorpion (Buthus tamulus) venom. Indian J Exp Biol (1989). 27(3): 242–44.

Abdoon NA, Ali AA, Alnema AA, Hag-ali M and Fatani AJ. Effect of selected anti-inflmammatory drugs on the lethal actions of Leiurus quinquestriatus venom. J Venom Anim Toxins Inclu Trop Diseases (2006). 12(3): On-line version ISSN 1678-9199, doi: 10.159/S1678-91992006000300003.

Sofer S. Scorpion envenomation. Intensive Care Med (1995). 21: 626–28.

Yugandhar B, Radha Krishna Murthy K, Sattar SA. Insulin administration in severe scorpion envenoming. J Venom Anim Toxins (1999). 5(2): 200– 19.

Radha Krishna Murthy K. The scorpion envenoming syndrome: A different perspective. The physiological basis of the role insulin in scorpion envenoming. J Venom Anim Toxins (2000). 6:(1): 4–51.

Radha Krishna Murthy K. Treatment of scorpion envenoming syndrome – need for scientific magnanimity. J Indian Med Assoc (2013). 111(4): 254– 59.

Radha Krishna Murthy K, Medh JD, Dave BN, Vakil YE, Billimoria FR. Acute pancreatitis and reduction of H+ ion concentration in gastric secretions in experimental acute myocarditis produced by Indian red scorpion (Buthus tamulus) venom. Indian J Exp Biol (1989). 27(3): 242–44.

Radha Krishna Murthy K, Yeolekar ME. Electrocardiographic changes in acute myocarditis produced by scorpion (Buthus tamulus) venom. Indian Heart J (1986). 38: 206–10.

Toppa NH, Martins P, Coloares CN, Freire-Maia L, Cunha-Melo JR. Effect of Tityus serrulatus scorpion toxin on gastrin levels in anaesthetized rat. Toxicon (1998). 36: 1833–42.

Radha Krishna Murthy K, Vakil AE, Yeolekar ME, Vakil YE. Reversal of metabolic and electrocardiographic changes induced by Indian red scorpion (Buthus tamulus) venom by administration of insulin, alpha blocker and sodium bicarbonate. Indian J Med Res (1988). 88: 450–57.

Radha Krishna Murthy K, Anita AG, Dave BN, Billimoria FR. Erythrocyte Na+- K+ ATPase activity inhibition and increase in red cell fragility in experimental myocarditis produced by Indian red scorpion venom. Indian J Med Res (1988). 88: 536– 40.

Murugesan S, Radha Krishna Murthy K, Noronha OPD, Samuel AM. 99 m Tc-scorpion venom: labelling, biodistribution and scintiimaging. J Venom Anim Toxins (1999). 5(1): 35–46.

Rezende NA, Amaral CFS and Freire-Maia L. Immunotherapy for scorpion envenoming in Brazil. Toxicon (1998). 36(11): 1507–13.

Amaral CFS, Lopes JA, Magalhaes RA, Derezende NA. Electrocardiographic, enzymatic and echocardiographic evidence of myocardial damage after Titus serrulatus poisoning. Am J Cardiol (1991). 67(7): 655–57.

Greenberger NJ, Toskes PP. Acute and chronic pancreatitis. In: Kasper D, Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL editors. Harrison’s Acute Pancreatitis in Scorpion Envenoming Syndrome: Insulin-Glucose Administration Reverses Haemodynamic Changes, Pulmonary Edema and Other Clinical Manifestations Due to Scorpion principles of internal medicine, 16th ed, vol II. New York: McGraw-Hill Medical Publishing Division, pp. 1895–906.

Radha Krishna Murthy K, Abbas Zare M, Haghnazari L. The use of serotheraphy to reserve ECG and cardiac enzyme changes caused by scorpion Mesobuthus tamulus concanesis, Pocock envenoming. J Venom Anim Toxins (1999). 5(2): 154–71.

Radha Krishna Murthy K, Shenoi R, Vaidyanathan P, Kelkar K, Sharma N, Neeta B, et al. Insulin reverses haemodynamic changes and pulmonary oedema in children stung by Indian red scorpion Mesobuthus tamulus Concanesis, Pocock. Ann Trop Med Parasitol (1991). 85(6): 651–57.




Creative Commons License
This work is licensed under a Creative Commons Attribution 3.0 License.

Print ISSN: 2347-6192

Online ISSN: 2347-6206