Research Paper - Research on Scorpion Sting
Dr.Suvarna N.Patil
(M.D).Medicine
Medical Administrator
B.K.L.W.Hospital, Dervan.
A 14 yrs. Old male patient with scorpion sting presented with pulmonary oedema and hemiplegia proven by C.T.Brain and 2 D Echo for LV function and use of anticoagulants for treating thrombotic stroke.
Scorpion sting and pulmonary oedema is a major problem in costal areas of Konkan but cerebro-vascular accidents due to scorpion bite (C.T.proved), are reported very rarely we report such a case report for its rarity.
A 14 yrs. Old boy, presented with history of scorpion bite 24 hours back with complaints of breathlessness and pink frothy sputum. On examination patient Was tachyponic with pulse rate 170/min, respiratory rate 40/min and Blood pressure 60mm Hg, systolic with signs of congestive cardiac failure in chest. One day 3 patient developed weakness in Right upper limb and lower limb with disorientation. On CNS examination Right planter as extensor, power on Right side was grade o and there was retention of urine.
ECG :depicted sinus Tachycardia with tall ‘T’ waves in V2-V6, non progression of ‘R’ waves from V2-V6, chest xray showed, pulmonary oedema, computerized Tomography of Brain showed multiple infarcts in left frontoparietaql region (Left lentiform nucleus and anterior limb of internal capsule) and Right temporal region (Right lentiform nucleus and part of posterior limb of internal capsule).
CPKMB 17 iu/lit, SGOT 5.0iu/lit.(day 1) CPKMB. 47iu/lit. SGOT 80.iu/lit,(day 3), Serum homocystine 72.8nm0/ml.
Serum Potassium- 4.4meg/lit.
Lipid Profile - Serum Cholesterol : 248mg%, serum
Triglycerides :121mg%, Serum HDL - 42mg%, Serum VLDL 24.2mg%, Cholesterol, HDL Ratio - 5.9, Serum LDL 181.8mg%, Bleeding time 1 min 59cc, Clotting time 4 min, Prothrombin Time 14 sec. With control 14 sec. Urea, Nitrogen 20mg%, Creatinine 1.0mg%, HIV - Non reactive (spot), FDP - positive.
2 D Echo : Showed poor LV function, dilated LV with LVEF : 15%. No clot seen in LV.
The case was diagnosed as scorpion bite, (cardiotoxic) poisoning presented as myocarditis, pulmonary oedema and Bilateral middle cerebral artery infarcts leading to Right sided hemiplegia.
Patient was treated with inj.frusemide 1mg/kg and 6 hourly with dobutamin in drip 10 micro/kg/min. Tab. Prazosine 0.5mg 6 hourly (first few hours patient was not in a position to take Tbs), Digoxin 0.5mg stat and then 0.25mg as a maintenance dose, Dopamine was given at a renal dose 5 micro/kg/min.
For Hemiplegia : Inj.mannitol was given in a dose of 100mg/kg 6 hourly. Inj.(low molecula weight heparin) 0.6ml/s/c, OD and physiotherapy was started. The patient made uneventful recovery and was adviced active and passive physiotherapy at home.
Scorpion sting is prevalent in few parts of the world and is a major health problem in Konkan areas of Maharashtra (3). Unlike the scorpion bite poisoning in Satara desert.& Rajasthan desert, the presentation of patient is different here in this region.
One of the studies done at universidad Nacinonal Autonoma de Mexico,two children had Neurological complication after scorpion sting. MRI suggested brain infarcts and the possible mechanism described by them was due to hypotension, shock or depressed LV function all of which are frequent in severe poisoning by scorpion sting (5).
One more case was detected at M.L.M.Medical college, Allahabad, where 16yrs. Old boy presenting with myocarditis with and pulmonary oedema followed by hemiplegia with patchy vasculitic lesions on C.T.(2).
In a study done by Dr.S.Mahadevan where effect of Venon on brain was studied and neurologic lesions, have been attributed to fibrin deposition resulting from DIC. These were confirmed in autopsy studies of human scorpion victim. Acute rise in blood pressure due to sympathetic stimulation, rupture of un-protected perforating arteries, Intracranial Haemorrhages and cerebral infarction due to DIC are possibly related to CNS manifestations (6).
In our case patient was investigated to rule out other predisposing factors for strokes. Amongst which serum homocystine level was found 72.8nmol/ml., Lipid Profile was also mildly deranged. Bleediang parameters were normal except positive FDP. As the picture was like thrombotic stroke low moleculate weight heparin was given to improve the circulation and patient showed uneventful recovery.
Whether venom itself caused cerebral infarction or presence of other on tributory factors like hyperlipedemia, hyperhomocystenemia along with scorpion venom predisposes the patient more for cerebral infarction needs further research work to prove it.
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