Hyperhidrosis–Hypertension–Hypotension in Scorpion Envenoming Syndrome: Insulin–Glucose Infusion Reverses All the Clinical Manifestations Caused by Massive Release of Counter-Regulatory Hormones due to Killer Scorpion (Buthidae family) Stings Murthy K. Radha Krishna1,*, Natu V.S.2, Kumar Z. Naveen3, Lavanya M.3 1Professor and Head, Department of Physiology, Santhiram Medical College and Santhiram General Hospital, National Highway 18, Nandyal, Kurnool District, Andhra Pradesh-518501, India 2Consultant Assistant Professor of Physiology, Vijayshree Hospital, Ghonasare, Chiplun, Ratnagiri, Maharashtra, India 3Department of Physiology, Santhiram Medical College and Santhiram General Hospital, National Highway 18, Nandyal, Kurnool District, Andhra Pradesh-518501, India *Corresponding author email id: kradhakrishnamurthy@yahoo.com
Online published on 3 August, 2016. Abstract Death due to poisonous scorpion (Buthidae family) stings is common in many of the developing countries all over the world. Severe uncontrollable pain at the site of sting (without local oedema) results in autonomic storm, release massive quantities of catecholamines, angiotensin II, ACTH, glucocorticoids, glucagon, ADH, aldosterone, either suppressed insulin secretion/or hyperinsulinemia – insulin resistance causing hyperglycemia and a sudden increase in Free Fatty Acid levels (FFA). The increase in catecholamine and angiotensin II hormonal levels cause hyperhidrosis, initial transient hypertension, hyper salivation, hypotension, mydriasis, miosis, DIC, acute pancreatitis, and many other clinical manifestations. Suddenly increased FFA levels are toxic, produce inactivation of Na+–K+ATPase activities, arrhythmias, conduction defects, myocardial infarction, cardiogenic pulmonary oedema, Acute Respiratory Distress Syndrome (ARDS), multisystem organ failure and death. Hyperhidrosis is harmful and wasteful loss of fluid and electrolytes resulting in peripheral circulatory failure, hypotension and death. Based on our animal experimental studies and treating the scorpion sting victims with insulin glucose infusion, we consider that insulin has a primary metabolic role in preventing and reversing hyperhidrosis, hypertension, hypotension, cardiovascular changes, cardiogenic and non-cardiogenic pulmonary (ARDS) oedema. Treatment: Continuous infusion of regular crystalline insulin 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 hour, supplementation of potassium (if required), and maintenance of acid–base fluid and electrolyte balance. Top Keywords Hyper-sweating, Hypotension, Scorpion stings, Mesobuthus tamulus concanesis, Pocock, Insulin– glucose infusion, Death. Top |