Impact of scorpion stings on electrocardiographic changes and relationship with body oxidant and antioxidant status

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Date: Apr. 30, 2014
From: Journal of Pakistan Medical Association(Vol. 64, Issue 4)
Publisher: Knowledge Bylanes
Document Type: Article
Length: 3,553 words
Lexile Measure: 1480L

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Byline: Behcet Al, Suat Zengin, Cuma Yildirim, Pinar Yarbil, Suleyman Ercan and Vedat Davutoglu

Abstract

Objecive: To investigate electrocardiogram changes due to scorpion stings and association between oxidative stress index, body oxidant/antioxidant system and the electrocardiogram changes.

Methods: The study was conducted at the Faculty of Medicine, Gaziantep University, Turkey, between May 2009 and October 2010. It comprised 44 patients admitted to the emergency department for scorpion sting, and a control group of matched age and gender of 20 persons. Electrocardiograms were taken promptly in the most painful phases of the patients. Cardiac parametres were measured. Erythrocyte packages were prepared to detect toxin/antioxidant levels. SPSS 18 was used for statistical analysis.

Results: Of the 44 patients, 22 (50%) were male. Overall average age of the patients was 45.22+-17.99 years. None of the patients required intensive care and none of them had limb losses. Cardiac parametres of the patients in electrocardiogram were higher (p Less than 0.05). Difference between those with changed electrocardiogram and unchanged electrocardiogram in terms of the values of total antioxidant status, total oxidant status, and oxidative stress index, were not statistically significant (p Greater than 0.05).

Conclusion: Scorpion stings associated with electrocardiogram changes. The mechanism of this relationship is not related with the status of body oxidative stress index and body oxidant and antioxidant capacity. Some parametres warrant further study in terms of potential serious arrhythmias in scorpionism.

Keywords: Scorpion sting, Electrocardiography, Oxidative stress. (JPMA 64: 423; 2014)

Introduction

Scorpionism and its consequences are an actual public health problem in several parts of the world; especially in north-Saharan Africa, Sahelian Africa, South Africa, Near and Middle-East, South India, Mexico and South Latin America, east of the Andes.1 The effects of the sting depend on the delivery dose of the scorpion poisoning, the age of the offender, the season, and the size of the victim.2 The severity of envenomation is related to haemodynamic and cardio-respiratory changes, with cardiogenic shock and pulmonary oedema being the main causes of death.3-6

The pathogenesis of cardiac dysfunction and myocardial damage secondary to scorpion envenomation had largely been the subject of debate in the past. The most accepted hypothesis was the increased catecholamine circulating secondary to a direct stimulatory effect of the venom on the adrenals and on sympathetic nerve endings. This hypothesis was confirmed by some clinical and experimental studies.7 In effect, it is possible that the venom affected the myocardial cell membranes directly, altering its permeability as well as electrical properties, and through abnormal electrolytes fluxes and shifts, causes functional damages. However, the myocardial dysfunction may be due to myocardial ischaemia.8 This hypothesis was advanced on some clinical, electrocardiographic, echocardiographic and radionuclide studies.9,10 All of these proposed mechanisms may act separately or simultaneously.

Catecholamine-mediated cardiac injury appears to be multifactorial and may be attributed to the relative hypoxia that occurs due to increased heart rate, coronary spasm and vasoconstriction of the microcirculation and due to direct toxic effects on myocardial cells brought about by increased intracellular calcium concentration.11 All these paradigms...

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Gale Document Number: GALE|A364278699