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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
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Classification and treatment of scorpion stings capable of causing autonomic storm

Classification and treatment of scorpion stings capable of causing autonomic storm
For assistance in managing a patient with a suspected scorpion envenomation, contact a regional poison control center (in the United States, call 1-800-222-1222).
Grade Clinical findings Treatment
I Local pain, erythema, and/or paresthesias at sting site
  • Pain management (eg, ibuprofen, cold therapy, or topical anesthesia; regional anesthesia [eg, digital block]) for severe local pain; opioids (eg, fentanyl or morphine for persistent severe pain) 
  • Local wound care
  • Tetanus prophylaxis
II Autonomic stimulation:
  • Parasympathetic: Diaphoresis, hypersalivation, priapism, vomiting, bronchorrhea, bronchospasm, lacrimation  
  • Sympathetic: Hypertension, tachycardia, cold extremities
Pancreatitis with severe abdominal pain (associated with Leiurus [Middle East and Asia] and Tityus [South America and Trinidad and Tobago] stings) 		As above and:
  • Species-specific antivenom*
  • Prazosin 0.5 mg (pediatric dose 30 mcg/kg up to a maximum single dose of 0.5 mg) every 3 hours until systemic toxicity resolves
  • Supportive care:
    • Frequent suctioning of copious oral secretions
    • Treat bronchospasm with albuterol; avoid subcutaneous epinephrine  
    • Atropine only for severe bradycardia or third degree AV block, otherwise atropine may potentiate sympathomimetic effects of envenomation
    • Maintain normal fluid and electrolyte balance, but avoid fluid overload
    • Antiemetics (eg, metoclopramide or, if no hypocalcemia or prolonged QTc, ondansetron)  
    • For patients with pancreatitis:
      • No oral intake
      • Treat pain with opioids (eg, fentanyl or morphine)
      • Treat persistent hyperglycemia and hypocalcemia
      • Maintain nutrition
      • Evaluate for local complications (eg, pancreatic pseudocyst or necrosis)
III As above and:
  • Pulmonary edema
  • Cardiac dysfunction (cardiogenic shock and cardiac arrhythmias) from autonomic-induced myocarditis and myocardial ischemia
  • Coagulopathy with hemiparesis and stroke (associated with Hottentotta [formerly Mesobuthus] stings in India)
As above and:
  • Provide respiratory support (noninvasive or mechanical ventilation)
  • Treat cardiogenic shock with vasoactive infusion with afterload reduction (eg, dobutamine)Δ
  • Manage cardiac arrhythmias, myocardial ischemia, and stroke according to international guidelines for advanced cardiac life support and stroke treatment◊. Because of its sympatholytic effects, amiodarone may be preferred over lidocaine for ventricular arrhythmias.
IV As above and:
  • Coma, seizures, and multiorgan failure caused by prolonged cardiogenic shock with decreased systemic vascular resistance and myocardial depression
As above and:
  • Benzodiazepine
  • Vasoactive infusion as for catecholamine-resistant cardiogenic shockΔ
* The recommendations for administration of scorpion-specific antivenom varies by species. Refer to UpToDate topics on scorpion envenomation causing autonomic dysfunction. Antivenom is most effective when given soon after envenomation (eg, within 6 to 8 hours). Whenever possible, antivenom should be administered in an acute care setting such as an emergency department or intensive care unit.
¶ Refer to UpToDate topics on the treatment of acute pancreatitis.
∆ Refer to UpToDate topics on the treatment of cardiogenic shock.
◊ Refer to UpToDate topics on advanced cardiac life support (ACLS) in adults, initial assessment and management of stroke, and pediatric advanced life support (PALS).
Adapted from: Isbister GK, Bawaskar HS. Scorpion envenomation. N Engl J Med 2014; 371:457.
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