Cardiac Sarcolemmal Defects in Acute Myocarditis Due to Scorpion Envenoming Syndrome

DOI: 10.4236/wjcd.2014.49054   PDF   HTML     2,914 Downloads   3,423 Views  


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.

Share and Cite:

Murthy, K. (2014) Cardiac Sarcolemmal Defects in Acute Myocarditis Due to Scorpion Envenoming Syndrome. World Journal of Cardiovascular Diseases, 4, 432-454. doi: 10.4236/wjcd.2014.49054.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Murthy, K.R.K. (2014) Enzymes and Toxins in Scorpions of Buthidae Family. Insulin-Glucose Administration Reverses Metabolic, Cardiovascular, ECG Changes and Pulmonary Edema in Scorpion Envenoming Syndrome. International Journal Medicine and Biosciences, 3, 9-25.
[2] Murthy, K.R.K. (2014) Hematological Changes in Acute Myocarditis Due to Scorpion Envenoming Syndrome. International Journal of Chemical and Life Sciences, 3, 111-126.
[3] Murthy, K.R.K. and Ravi, B.P. (2014) Laryngeal Spasm in Scorpion Envenoming Syndrome. Indian Journal of Mednodent and Allied Sciences, 2, 41-48.
[4] Murthy, K.R.K. (2014) Hypertension, Autonomic Storm, Increased Counter Regulatory Hormones and Suppressed Insulin Acute Myocarditis in Scorpion Envenoming Syndrome. World Journal of Cardiovascular Diseases, 4, 189-210.
[5] Amaral, C.F.S. and Rezende, N.A. (1997) Both Cardiogenic and Non-Cardiogenic Factors Are Involved in the Pathogenesis of Pulmonary Oedema after Scorpion Envenoming. Toxicon, 35, 997-998.
[6] Amaral, C.F.S., Barbosa, A.J.A., Leite, V.H.R., Tafuri, W.L. and de Rezende, N.A. (1994) Scorpion Sting-Induced Pulmonary Oedema: Evidence of Increased Alveolocapillary Membrane Permeability. Toxicon, 32, 999-1003.
[7] Bahloul, M., Rekik, N., Chabchoub, I., Chaari, A., Ksibi, H., Damak, H., Chaari, A., Hamida, C.B., Chelly, H. and Bouaziz, M. (2001) Neurological Complications Secondary to Severe Scorpion Envenomation. Medical Science Monitor, 11, CR196-202.
[8] Bagchi, S. and Deshpande, S.B. (2001) Scorpion (Buthus tamulus) Venom Toxicity on Cardiopulmonary Reflexes Involves Kinins via 5-HT3 Receptor Subtypes. Journal of Venomous Animals and Toxins, 7, 25-44.
[9] Balasubramaniam, P. and Murthy, K.R.K. (1981) Abnormal Cardiovascular and Electrocardiographic Profile and Cardiac Glycogen Content in Rabbits Injected with Scorpion Venom. Indian Journal of Physiology and Pharmacology, 25, 351-355.
[10] Balasubramaniam, P. and Murthy, K.R.K. (1984) Liver Glycogen Depletion in Acute Myocarditis Produced by Scorpion (Buthus tamulus) Venom. Indian Heart Journal, 36, 101-104.
[11] Bartholomew, C. (1970) Acute Scorpion Pancreatitis in Trinidad. British Medical Journal, 1, 666-668.
[12] Bucaretchi, F., Baracat, E.C., Nogueira, R.J., Chaves, A., Zambrone, F.A., Fonseca, F.A. and Tourinho, F.S. (1995) A Comparative Study of Severe Scorpion Envenomation in Children Caused by Tityus bahiensis and Tityus serrulatus. Revista do Instituto de Medicina Tropical de Sao Paulo, 37, 331-336.
[13] Freire-Maia, L., Campos, J.A. and Amaral, C.F.S. (1994) Approaches to the Treatment of Scorpion Envenoming. Toxicon, 32, 1009-1014.
[14] Gueron, M., Adolph, R., Gruff, L., Grup, O., Gabel, M. and Fowler, N.O. (1980) Hemodymamics and Myocardial Consequences of Scorpion Venom. The American Journal of Cardiology, 45, 979-986.
[15] Gueron, M., Ilias, R., Shahak, E. and Sofer, S. (1992) Renin and Aldosterone Levels Following Envenoming by Leiurus quinquestriatus. Toxicon, 30, 765-767.
[16] Ismail, M. and Abd-Elsalam, M.A. (1988) Are the Toxicological Effects of Scorpion Envenomation Related to Tissue Venom Concentration? Toxicon, 26, 233-256.
[17] Ismail, M., Fatani, A.Y. and Dabeas, T.T. (1992) Experimental Treatment Protocols for Scorpion Envenomation: A Review of Common Therapies and on Effect of Kallikrein-Kinin Inhibitors. Toxicon, 30, 1257-1279.
[18] Ismail, M. (1993) Serotherapy of the Scorpion Envenoming Syndrome Is Irrationally Convicted without Trial. Toxicon, 31, 1077-1083.
[19] Ismail, M. (1995) The Scorpion Envenoming Syndrome. Toxicon, 33, 825-858.
[20] Murthy, K.R.K. and Saxena, I.D. (1979) Investigations on Sarcolemmal ATPase Activities in Ventricular Tissues of Swimming Trained and Sedentary Rats. Indian Journal of Experimental Biology, 17, 277-280.
[21] Murthy, K.R.K. (1982) Investigations of Cardiac Sarcolemmal ATPase Activity in Rabbits with Acute Myocarditis Produced by Scorpion (Buthus tamulus) Venom. Japanese Heart Journal, 23, 835-842.
[22] Murthy, K.R.K. and Anita, A.G. (1986) Reduced Insulin Secretion in Acute Myocarditis Produced by Scorpion (Buthus tamulus) Venom. Indian Heart Journal, 38, 467-469.
[23] Murthy, K.R.K. and Haghnazari, L. (1999) Blood Levels of Glucagon, Cortisol and Insulin Following Scorpion (Mesobuthus tamulus concanesis, Pocock) Envenoming in Dogs. Journal of Venomous Animals and Toxins, 5, 47-55.
[24] Murthy, K.R.K., Billimoria, F.R., Khopkar, M. and Dave, K.N. (1986) Acute Hyperglycemia and Hyperkalemia in Acute Myocarditis Produced by Scorpion (Buthus tamulus) Venom Injection in Dogs. Indian Heart Journal, 38, 71-74.
[25] Murthy, K.R.K., Dubey, A.S., Abbas, Z.M. and Haghnazari, L. (2003) Investigations on the Role of Insulin and Scorpion Antivenom in Scorpion Envenoming Syndrome. Journal of Venomous Animals and Toxins Including Tropical Diseases, 9, 202-238.
[26] Murthy, K.R.K. and Hossein, Z. (1986) Increased Osmotic Fragility of Red Cells after Incubation at 37?C for 24 Hours in Dogs with Acute Myocarditis Produced by Scorpion (Buthus tamulus) Venom. Indian Journal of Experimental Biology, 38, 206-210.
[27] Murthy, K.R.K. and Medh, J.D. (1986) Increase in Serum Free Fatty Acids. Phospholipids and Reduction in Total Cholesterol in Acute Myocarditis Produced by Scorpion (Buthus tamulus) Venom. Indian Heart Journal, 38, 369-372.
[28] Murthy, K.R.K. and Vakil, A.E. (1988) Elevation of Plasma Angiotensin Levels in Dogs by Indian Red-Scorpion (Buthus tamulus) Venom and Its Reversal by Administration of Insulin and Tolazoline. Indian Journal of Medical Research, 88, 376-379.
[29] Murthy, K.R.K. and Yeolekar, M.E. (1986) Electrocardiographic Changes in Acute Myocarditis Produced by Scorpion (Buthus tamulus) Venom. Indian Heart Journal, 38, 206-210.
[30] Murthy, K.R.K., Vakil, A.E., Yeolekar, M.E. and Vakil, Y.E. (1988) Reversal of Metabolic and Electrocardiographic Changes Induced by Indian Red Scorpion (Buthus tamulus) Venom by Administration of Insulin, Alpha Blocker and Sodium Bicarbonate. Indian Journal of Medical Research, 88, 450-457.
[31] Murthy K.R.K., Anita, A.G., Dave, B.N. and Billimoria, F.R. (1988) Erythrocyte Na+ -K+ ATPase Activity Inhibition and Increase in Red Cell Fragility in Experimental Myocarditis Produced by Indian Red Scorpion Venom. Indian Journal of Medical Research, 88, 536-540.
[32] Murthy, K.R.K., Medh, J.D., Dave, B.N., Vakil, Y.E. and Billimoria, F.R. (1990) Acute Pancreatitis and Reduction of H+ Ion Concentration in Gastric Secretions in Experimental Acute Myocarditis Produced by Indian Red Scorpion (Buthus tamulus) Venom. Indian Journal of Experimental Biology, 27, 242-244.
[33] Murthy, K.R.K., Vakil, A.E. and Yeolekar, M.E. (1990) Insulin Administration Reverses the Metabolic and Electrocardiographic Changes Induced by Indian Red Scorpion (Buthus tamulus) Venom in the Experimental Dogs. Indian Heart Journal, 48, 35-42.
[34] Murthy, K.R.K., Shenoi, R., Vaidyanathan, P., Kelkar, K., Sharma, N., Neeta, B., Rao, S. and Mehta, M.N. (1991) Insulin Reverses Haemodynamic Changes and Pulmonary Oedema in Children Stung by Indian Red Scorpion Mesobuthus tamulus concanesis, Pocock. Annals of Tropical Medicine and Parasitology, 85, 651-657.
[35] Murthy, K.R.K. (2000) The Scorpion Envenoming Syndrome: A Different Perspective. The Physiological Basis of the Role Insulin in Scorpion Envenoming. Journal of Venomous Animals and Toxins, 6, 04-51.
[36] Murthy, K.R.K. (2013) Treatment of Scorpion Envenoming Syndrome—Need for Scientific Magnanimity. Journal of Indian Medical Association, 111, 254-259.
[37] Yugandhar, B., Murthy, K.R.K. and Sattar, S.A. (1999) Insulin Administration in Severe Scorpion Envenoming. Journal of Venomous Animals and Toxins, 5, 200-219.
[38] Devi, S., Reddy, C.N., Devi, S.L., Subramaniam, Y.R., Murthy, D.P. and Reddy, C.R. (1970) Defibrination Syndrome Due to Scorpion Poisoning. British Medical Journal, 1, 345-347.
[39] Murthy, K.R.K., Hossein, Z., Medh, J.D., Kudalkar, J.A., Yeolekar, M.E., Pandit, S.P., Khopkar, M., Dave, K.N. and Billimoria, F.R. (1988) Disseminated Intravascular Coagulation & Disturbances in Carbohydrate and Fat Metabolism in Acute Myocarditis Produced by Indian Red Scorpion (Buthus tamulus) Venom. Indian Journal of Medical Research, 87, 318-325.
[40] Ganong, W.G. (1987) Review of Medical Physiology. 13rd Edition, Appleton and Lange, New York, 283.
[41] Keele, C.A., Neil, E. and Joels, N. (2000) Samson Wright’s Applied Physiology. 13rd Edition, Oxford University Press, Oxford, 405-512.
[42] Jackson, E.K. (2006) Renin and Angiotensin Goodman & Gilman’s the Pharmacological Basis of Therapeutics. 11st Edition, Brunton, L.L., Lazo, J.S. and Parker, K.L., Eds., McGraw-Hill Medical Publishing Division, New York, New Delhi, 795.
[43] Cecil (1976) Textbook of Medicine. 15th Edition, Beason, P.B., McDermott, W. and Wyngaarden, J.B., Eds., WB Saunders Co., Philadelphia & Heinemann, London, 485.
[44] Braunwald’s Heart Disease (2011) Acute Myocarditis. 9th Edition, Bonow, R.O., Mann, D.L., Zipes, D.P. and Libby, P., Eds., Elsevier Saunder, Philadelphia, 1602-1610.
[45] Oxford Textbook of Medicine (2003) Injuries, Envenoming, Poisoning, and Allergic Reactions Caused by Animals. 4th Edition, Vol. 1, Warrel, D.A., Cox, T.M. and Firth, J.D., Eds., Oxford University Press, Oxford, 941-946.
[46] Davidson’s Principles & Practice of Medicine (2010) Envenoming. 21st Edition, Colledge, N.R., Walker, B.R. and Ralston, S.H., Eds., Churchill, Livingstone, Elsevier, 223-228.
[47] Kumar, P. and Clark, M. (2005) Scorpions. In: Kumar, P. and Clark, M., Eds., Clinical Medicine, Elsevier Saunders, Philadelphia, 1021.
[48] Current Medical Diagnosis & Treatment (2012) Scorpion Stings. 51st Edition, McPhee, S.J. and Papadakis, M.A., Eds., McGraw Hill Lange, 1545.
[49] Rosen’s Emergency Medicine (2006) Concepts and Clinical Practice. In: Marx, J.A., Ed., Venomous Animals, Mosby Elsevier, 907-908.
[50] Maguire, J.H., Pollack, R.J. and Spielman, A. (2005) Ectoparasite Infestations and Arthropod Bites and Stings. In: Kasper, D.L., Braunwauld, E., Fauci, A., Hauser, S., Longo, D. and Jameson, J., Eds., Harrison’s Principles of Internal Medicine, McGraw-Hill Medical Publishing Division, 2604.
[51] Poon, K.T. (1963) Treatment of Scorpion Sting. British Medical Journal, 1, 1016.
[52] Gueron, M., Stern, J. and Cohen, W. (1967) Severe Myocardial Damage and Heart Failure in Scorpion Sting. American Journal of Cardiology, 19, 719-725.
[53] Sofer, S. and Gueron, M. (1988) Respiratory Failure in Children Following Envenomation by the Scorpion Leiurus quinquestriatus: Haemodynamic and Neurological Aspects. Toxicon, 26, 931-939.
[54] Gueron, M., Marqulis, G. and Sofer, S. (1990) Echoardiographic and Radionuclide Angiographic Observations Following Scorpion Envenomation by Leiurus quinquestriatus. Toxicon, 28, 1005-1009.
[55] Murthy, K.R.K. and Zare, A.Z. (2002) Scorpion Antivenom Reverses Metabolic, Electrocardiographic, and Hormonal Disturbances Caused by the Indian Red Scorpion Mesobuthus tamulus concanesis, Pocock Envenomation. Journal of Venomous Animals and Toxins Including Tropical Diseases, 8, 30-48.
[56] Murthy, K.R.K., Zare, A.Z. and Haghnazari, L. (1999) The Use of Serotheraphy to Reverse ECG and Cardiac Enzyme Changes Caused by Scorpion Mesobuthus tamulus concanesis, Pocock Envenoming. Journal of Venomous Animals and Toxins, 5, 154-171.
[57] Duddin, A.A., Rambaud-Cousson, A., Thalji, A., Juabeh, I.I. and Abu-Libdeh, M. (1991) Scorpion Sting in Children in the Jerusalem Area: A Review of 54 Cases. Annals of Tropical Paediatrics, 11, 217-223.
[58] D’Suze, G., Comellas, A., Pesca, L., Sevci, K.C. and Sanchez-de-León, R. (1999) Tityus discrepans Venom Produces a Respiratory Distress Syndrome in Rabbits through an Indirect Mechanism. Toxicon, 37, 173-180.
[59] Johnson, D.G., Henry, D.P., Moss, J. and Williams, H.H. (1976) Inhibition of Insulin Released by Scorpion Toxin on Rat Pancreatic Islets. Diabetes, 25, 198-201.
[60] Johnson, D.G. and Ensinck, J.W. (1976) Stimulation of Glucagon Secretion by Scorpion Toxin in the Perfused Rat Pancreas. Diabetes, 25, 645-649.
[61] Douglas, W.W. (1986) Homeostasis: Body Changes in Trauma and Surgery. In: Sabiston Jr., D.C., Ed., Textbook of Surgery, WB Saunders, Philadelphia, 23-37.
[62] Bondy, P.K. and Rosenberg, L.E. (1980) Metabolic Control and Disease. 8th Edition, WB Saunders Co., Philadelphia/ London/ Toronto, p. 1621.
[63] Fyge, T., Cochran, K.M., Bacter, R.H. and Booth, E.M. (1971) Plasma Lipid Changes after Myocardial Infarction. The Lancet, 298, 997-1001.
[64] Izzo Jr., J.L. and Swislocki, L.M. (1991) Workshop III—Insulin Resistance: Is It Truly the Link? The American Journal of Medicine, 90, S26-S31.
[65] Pandey, S.V. and Mead, J.F. (1968) Inhibition of Enzyme Activities by Free Fatty Acids. The Journal of Biological Chemistry, 243, 6180-6186.
[66] Vik-Mo, H. and Mjos, O.D. (1981) Influence of Free Fatty Acids on Myocardial Oxygen Consumption and Ischemic Injury. The American Journal of Cardiology, 48, 361-367.
[67] Goldstein, R.E., Abumrad, N.N., Wasserman, D.H. and Cherrington, A.D. (1995) Effects of an Acute Increase in Epinephrine and Cortisol on Carbohydrate Metabolism during Insulin Deficiency. Diabetes, 44, 672-681.
[68] Dhalla, N.S., Das, P.K. and Sharma, G.P. (1978) Subcellular Basis of Cardiac Contractile Failure. Journal of Molecular and Cellular Cardiology, 10, 363-385.
[69] Dhalla, N.S., Sulakhe, P.V., Lee, S.L., Singal, P.K., Varley, K.G. and Yates, J.C. (1980) Subcellular Ca2+ Transport in Different Areas of Dog Heart. Canadian Journal of Physiology and Pharmacology, 58, 360-367.
[70] Dhalla, N.S., McNamara, D.B. and Anand, M.B. (1975) Heart Sarcolemma as a Dynamic Excitable Membrane. In: Roy, P.E. and Dhalla, N.S., Eds., Recent Advances in Studies on Cardiac Structure and Metabolism, The Sarcolemma, University Park Press, Baltimore, 1.
[71] Dhalla, N.S., Ziegelhoffer, A. and Harrow, J.A. (1977) Regulatory Role of Membrane Systems in Heart Function. Ca- nadian Journal of Physiology and Pharmacology, 55, 1221-1234.
[72] McNamara, D.B., Sulakhe, P.V., Singh, J.N. and Dhalla, N.S. (1974) Properties of Heart Sarcolemmal Na+ -K+ ATPase. The Journal of Biochemistry, 75, 795-803.
[73] Skou, J.C. (1992) The Na+ -K+ Pump. News in Physiological Sciences, 7, 95-100.
[74] Sulakhe, P.V. and Dhalla, N.S. (1971) Excitation-Contraction Coupling in Heart VI. Demonstration of Calcium Activated ATPase in the Dog Heart Sarcolemma. Life Sciences, 10, 185-191.
[75] Sulakhe, P.V. and Louis, P.J. (1980) Passive and Active Calcium Fluxes across Plasma Membranes. Progress in Biophysics and Molecular Biology, 35, 135-195.
[76] Oliver, M.F. (1975) The Vulnerable Ischemic Myocardium and Its Metabolism. In: Oliver, M.F., Ed., Modern Trends in Cardiology, Butterworths, London, 280-291.
[77] Choudhary, P. (2006) Mechanism of Action of Insulin in Reversing the Indian Red Scorpion Envenomation in Rats. Thesis, Banaras Hindu University, Varanasi.
[78] Abdel-Haleem, A.H., Meki, A.R., Noaman, H.A. and Mohamed, Z.T. (2006) Serum Levels of IL-6 and Its Soluble Receptor, TNF-α and Chemochine RANTES in Scorpion Envenomed Children. Their Relation to Scorpion Envenomation Outcome. Toxicon, 47, 437-444.
[79] Clausen, T. (1986) Regulation of Active Na+ -K+ Transport in Skeletal Muscle. Physiological Review, 66, 542-580.
[80] Clausen, T. (1998) Clinical and Therapeutic Significance of the Na, K Pump. Clinical Science, 95, 3-17.
[81] Clausen, T. (2003) Na+-K+ Pump Regulation and Skeletal Muscle Contractility. Physiological Review, 83, 1269-1324.

comments powered by Disqus

Copyright © 2020 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.