[Antiadrenergic rescue therapy with amiodarone in children with severe left ventricular dysfunction secondary to scorpion envenomation].
BACKGROUND
Children with scorpion envenomation have massive sympathetic activation and variable degrees of left ventricular systolic dysfunction.


OBJECTIVE
To evaluate a rescue protocol for children with severe left ventricular dysfunction secondary to scorpion envenomation.


METHODS
Four children, after scorpion envenomation, were subjected to a rescue protocol for acute left ventricular dysfunction: Endotracheal intubation and respiratory assistance, electrocardiograms, chest x-Ray, echocardiograms and blood samples for norepinephrine and troponin I serum levels. Samples and echocardiograms were repeated at 12, 24 and 48 hours. Intravenous medications: Dobutamine: 4-6 microg/kg/min. Amiodarone: 3 mg/kg during a 2 hour period. Maintenance: 5 mg/kg/day. Furosemide: 0.5 mg/kg/dose. Diuretics were given when the systemic blood pressure was above percentile fifty. Amiodarone, Dobutamine and Furosemide were administered during the first 48 hours. Beta-adrenergic blockers and angiotensin converting enzyme were given, at 48 hours after admission, once the left ventricular Ejection fraction > 0.35 and the clinical status had improved.


RESULTS
On admission, norepinephrine was 1,727.50 +/-794.96 pg/ml, troponin I 24.53 +/- 14.09 ng/ml and left ventricular ejection fraction 0.20 +/- 0.056. At twelve hours, norepinephrine and troponin I serum levels were down to half of the initial values and the ejection fraction increased to 0.32 +/- 0.059. During the next 24 and 48 hours, the ejection fraction rose to 0.46 +/- 0.045, (p<0.01) and norepinephrine and troponin diminished to 526.75 +/- 273.73 (p < 0.02) and 2.20 +/- 2.36 (p<0.02) respectively.


CONCLUSIONS
Amiodarone, by acting as a neuromodulator, is very likely responsible for the early and progressive decrease of serum norepinephrine.
Santiago
Justo J
JJ
Instituto de Investigaciones Cardiovasculares, Universidad de los Andes, Mérida, Venezuela. justos@ula.ve
Dávila
Carmen A Mazzei de
CA
Davila
Diego F
DF
Donis
Jose H
JH
Villaroel
Vanesa
V
D000293:Adolescent; D018674:Adrenergic Antagonists / Q000627:therapeutic use*; D000638:Amiodarone / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D012604:Scorpion Venoms / Q000506:poisoning*; D018487:Ventricular Dysfunction, Left / Q000139:chemically induced / Q000188:drug therapy*
D018674:Adrenergic Antagonists; D012604:Scorpion Venoms; D000638:Amiodarone