Haemodynamic patterns in patients with scorpion envenomation.
OBJECTIVE
To study cardiovascular haemodynamics following scorpion envenomation.


METHODS
Intensive care unit of a university hospital.


METHODS
Eight patients with Indian red scorpion (Mesobuthus tamulus) stings.


METHODS
Captopril (6.25 to 12.5 mg orally) every 30 minutes until pulmonary oedema resolved.


METHODS
Haemodynamic data obtained by pulmonary artery catheterisation.


RESULTS
Two haemodynamic patterns were seen. There was a predominant vascular effect in one patient, with severe hypertension, tachycardia, increased systemic vascular resistance index (SVRI = 5893 dyn.s.cm-5), and normal cardiac index (2.73 l/m2). A predominant myocardial effect with left ventricular dysfunction and normal right ventricular function was seen in the other seven patients, with tachycardia, pulmonary oedema, mild hypotension, reduced stroke volume (mean (SD), 25.9 (8.3) ml/m2), normal SVRI (1812 (831) dyn.s.cm-5), and increased pulmonary artery wedge pressure (PAWP = 25 (4.4) mm Hg). Following mild dehydration pulmonary oedema subsided (PAWP = 14 (8.5) mm Hg) in three of these patients, but hypovolaemic shock developed (right atrial pressure (RAP) = 1.3 (2.1) mm Hg); pulmonary oedema recurred with rehydration. One patient developed fatal cardiogenic shock with raised PAWP (27 mm Hg) and RAP (11 mm Hg), and vasodilatation (SVRI = 1129 dyn.s.cm-5). Stroke volume (30.5 (8.7) ml/m2) and cardiac output (4.3 (1.5) 1/m2) improved with resolution of pulmonary oedema (PAWP = 14.4 (4.2) mm Hg) following afterload reduction with captopril.


CONCLUSIONS
Mild envenomation causes severe vasoconstriction and hypertension. Severe envenomation produces predominant left ventricular dysfunction with normal systemic vascular resistance manifesting as pulmonary oedema or severe hypotension depending on the fluid balance. Shock due to biventricular dysfunction and vasodilatation occurs terminally.
Karnad
D R
DR
Department of Medicine, King Edward VII Memorial Hospital, Parel, Bombay, India.
D000293:Adolescent; D000328:Adult; D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002216:Captopril / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology; D011669:Pulmonary Wedge Pressure; D065008:Scorpion Stings / Q000150:complications / Q000503:physiopathology*; D012605:Scorpions; D012770:Shock, Cardiogenic / Q000209:etiology; D014661:Vasoconstriction; D018754:Ventricular Dysfunction / Q000209:etiology
D000959:Antihypertensive Agents; D002216:Captopril