What are the treatments for hyperdynamic and hypodynamic cardiovascular effects of scorpion envenomation?

Updated: Nov 09, 2018
  • Author: David Cheng, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

For hyperdynamic cardiovascular changes, administration of a combination of beta-blockers with sympathetic alpha-blockers is most effective in reversing this venom-induced effect. Avoid using beta-blockers alone because this leads to an unopposed alpha-adrenergic effect. Also, nitrates can be used for hypertension and myocardial ischemia.

For hypodynamic cardiac changes, a titrated monitored fluid infusion with afterload reduction helps reduce mortality. A diuretic may be used for pulmonary edema in the absence of hypovolemia, but an afterload reducer, such as prazosin, nifedipine, nitroprusside, hydralazine, or angiotensin-converting enzyme inhibitors, is better. Inotropic medications, such as digitalis, have little effect, while dopamine aggravates the myocardial damage through catecholaminelike actions. Dobutamine may be a better choice for the inotropic effect. [35] Finally, a pressor such as norepinephrine can be used as a last resort to correct hypotension refractory to fluid therapy.

Administer atropine to counter venom-induced parasympathomimetic effects.


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