Search tips
Search criteria 


Logo of heartHeartVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Heart. 1998 May; 79(5): 485–489.
PMCID: PMC1728680

Haemodynamic patterns in patients with scorpion envenomation


Objective—To study cardiovascular haemodynamics following scorpion envenomation.
Setting—Intensive care unit of a university hospital.
Patients—Eight patients with Indian red scorpion (Mesobuthus tamulus) stings.
Intervention—Captopril (6.25 to 12.5 mg orally) every 30 minutes until pulmonary oedema resolved.
Main outcome measures—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, 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)−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 = 1129−5). Stroke volume (30.5 (8.7) ml/m2) and cardiac output (4.3 (1.5) l/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.

Keywords: scorpion sting;  myocarditis;  pulmonary oedema;  animal toxin

Full Text

The Full Text of this article is available as a PDF (98K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bawaskar HS, Bawaskar PH. Scorpion envenoming and the cardiovascular system. Trop Doct. 1997 Jan;27(1):6–9. [PubMed]
  • Bawaskar HS, Bawaskar PH. Stings by red scorpions (Buthotus tamulus) in Maharashtra State, India: a clinical study. Trans R Soc Trop Med Hyg. 1989 Nov-Dec;83(6):858–860. [PubMed]
  • Ramachandran LK, Agarwal OP, Achyuthan KE, Chaudhury L, Vedasiromani JR, Ganguly DK. Fractionation and biological activities of venoms of the Indian scorpions Buthus tamulus and Heterometrus bengalensis. Indian J Biochem Biophys. 1986 Dec;23(6):355–358. [PubMed]
  • Sofer S. Scorpion envenomation. Intensive Care Med. 1995 Aug;21(8):626–628. [PubMed]
  • Moss J, Kazić T, Henry DP, Kopin IJ. Scorpion venom-induced discharge of catecholamines accompanied by hypertension. Brain Res. 1973 May 17;54:381–385. [PubMed]
  • Henriques MC, Gazzinelli G, Diniz CR, Gomez MV. Effect of the venom of the scorpion Tityus serrulatus on adrenal gland catecholamines. Toxicon. 1968 Feb;5(3):175–179. [PubMed]
  • Murthy KR, Vakil AE. Elevation of plasma angiotensin levels in dogs by Indian red scorpion (Buthus tamulus) venom & its reversal by administration of insulin+tolazoline. Indian J Med Res. 1988 Oct;88:376–379. [PubMed]
  • Margulis G, Sofer S, Zalstein E, Zucker N, Ilia R, Gueron M. Abnormal coronary perfusion in experimental scorpion envenomation. Toxicon. 1994 Dec;32(12):1675–1678. [PubMed]
  • Murthy RK, Medh JD. Increase in serum free fatty acids, phospholipids and reduction in total cholesterol in acute myocarditis produced by scorpion (Buthus tamulus) venom injection in dogs. Indian Heart J. 1986 Sep-Oct;38(5):369–372. [PubMed]
  • Wang R, Moreau P, Deschamps A, de Champlain J, Sauvé R, Foucart S, Bai L, Lu XR. Cardiovascular effects of Buthus martensii (Karsch) scorpion venom. Toxicon. 1994 Feb;32(2):191–200. [PubMed]
  • Almeida AP, Alpoim NC, Freire-Maia L. Effects of a purified scorpion toxin (tityustoxin) on the isolated guinea pig heart. Toxicon. 1982;20(5):855–865. [PubMed]
  • Gueron M, Sofer S. Vasodilators and calcium blocking agents as treatment of cardiovascular manifestations of human scorpion envenomation. Toxicon. 1990;28(2):127–128. [PubMed]
  • Bawaskar HS, Bawaskar PH. Prazosin for vasodilator treatment of acute pulmonary oedema due to scorpion sting. Ann Trop Med Parasitol. 1987 Dec;81(6):719–723. [PubMed]
  • Karnad DR, Deo AM, Apte N, Lohe AS, Thatte S, Tilve GH. Captopril for correcting diuretic induced hypotension in pulmonary oedema after scorpion sting. BMJ. 1989 May 27;298(6685):1430–1431. [PMC free article] [PubMed]
  • el-Amin EO. Issues in management of scorpion sting in children. Toxicon. 1992 Jan;30(1):111–115. [PubMed]
  • Abroug F, Ayari M, Nouira S, Gamra H, Boujdaria R, Elatrous S, Ben Farhat M, Bouchoucha S. Assessment of left ventricular function in severe scorpion envenomation: combined hemodynamic and echo-Doppler study. Intensive Care Med. 1995 Aug;21(8):629–635. [PubMed]
  • Gueron M, Ovsyshcher I. What is the treatment for the cardiovascular manifestations of scorpion envenomation? Toxicon. 1987;25(2):121–130. [PubMed]
  • Gueron M, Adolph RJ, Grupp IL, Gabel M, Grupp G, Fowler NO. Hemodynamic and myocardial consequences of scorpion venom. Am J Cardiol. 1980 May;45(5):979–986. [PubMed]
  • De Rezende NA, Dias MB, Campolina D, Chavez-Olortegui C, Diniz CR, Amaral CF. Efficacy of antivenom therapy for neutralizing circulating venom antigens in patients stung by Tityus serrulatus scorpions. Am J Trop Med Hyg. 1995 Mar;52(3):277–280. [PubMed]
  • Amaral CF, Lopes JA, Magalhães RA, de Rezende NA. Electrocardiographic, enzymatic and echocardiographic evidence of myocardial damage after Tityus serrulatus scorpion poisoning. Am J Cardiol. 1991 Mar 15;67(7):655–657. [PubMed]
  • Bawaskar HS, Bawaskar PH. Management of the cardiovascular manifestations of poisoning by the Indian red scorpion (Mesobuthus tamulus). Br Heart J. 1992 Nov;68(5):478–480. [PMC free article] [PubMed]
  • Pécoud A, Francioli P, Pradervand D, Perret C. Haemodynamics in phaeochromocytoma. A report of 2 cases. Intensive Care Med. 1979 Sep;5(3):143–146. [PubMed]
  • Stenström G, Kutti J. The blood volume in pheochromocytoma patients before and during treatment with phenoxybenzamine. Acta Med Scand. 1985;218(4):381–387. [PubMed]
  • Ismail M, Fatani AJ, Dabees TT. Experimental treatment protocols for scorpion envenomation: a review of common therapies and an effect of kallikrein-kinin inhibitors. Toxicon. 1992 Oct;30(10):1257–1279. [PubMed]

Figures and Tables

Figure 1
Postulated sequence of events following scorpion envenomation. Haemodynamic changes may result from either predominantly vascular or predominantly myocardial effects of the venom. While a transition from the vascular to the myocardial pattern has been ...

Articles from Heart are provided here courtesy of BMJ Publishing Group