TITLE:
Cardiac Sarcolemmal Defects in Acute Myocarditis Due to Scorpion Envenoming Syndrome
AUTHORS:
K. Radha Krishna Murthy
KEYWORDS:
Scorpion Envenoming Syndrome, Suppressed Insulin Secretion, Inhibition of Na+ - K+ ATPase Activities, Mg++ ATPase and Ca2+ ATPase Activities Insulin Infusion
JOURNAL NAME:
World Journal of Cardiovascular Diseases,
Vol.4 No.9,
August
25,
2014
ABSTRACT:
Death due to scorpion envenoming syndrome is a common event in tropical
and subtropical countries. Severe scorpion envenoming causes autonomic storm,
massive release of catecholamines, counter-regulatory hormones, suppressed
insulin/hyperinsulinemia, acute myocarditis, hyperglycemia, increased free
fatty Acid levels, acute pancreatitis, disseminated intra-vascular coagulation,
acute pulmonary oedema and death. Severe scorpion envenoming causes cardiac
sarcolemmal defects displayed by alterations in Na+ - K+ ATPase, Mg++ ATPase and Ca2+ ATPase activities,
inhibition of erythrocyte Na+ - K+ ATPase activities,
hyperkalemia and may result in death. Based on our animal experiments in which
insulin administration reversed the metabolic and ECG changes induced by
scorpion envenoming and treating the poisonous scorpion sting victims with
insulin, we consider that insulin has a primary metabolic role in preventing
and reversing acute myocarditis, the cardiovascular, haemodynamic, and neurological
manifestations and pulmonary oedema induced by scorpion envenoming.
Administration of insulin-glucose infusion to scorpion sting victims appears to
be the physiological basis for the control of the metabolic response when that
has become a determinant to survival. Continuous infusion of regular
crystalline insulin should be given at the rate of 0.3 U/g glucose and glucose
at the rate of 0.1 g/kg body weight/hour, for 48 - 72 hours, with
supplementation of potassium as needed and maintenance of fluid, electrolytes
and acid-base balance. The observation of cardiac sarcolemmal defects and
physiological basis of various patho-physiological mechanisms involved in the
genesis of scorpion envenoming syndrome and its reversal (in the experimental
animals and scorpion sting victims) by administration of insulin are reviewed.