Materiały źródłowe

• #1 Scorpion sting – Wikipedia

  https://en.wikipedia.org/wiki/Scorpion_sting

  A scorpion sting is an injury caused by the stinger of a scorpion resulting in the medical condition known as scorpionism, which may vary in severity. […] In serious cases, scorpion stings may involve the envenomation of humans by toxic scorpions, which may result in extreme pain, serious illness, or even death depending on the toxicity of the venom. […] Envenomation of a human by a scorpion may affect the sympathetic or parasympathetic systems depending on the species of scorpion. Some of the more severe side effects include respiratory distress syndrome, pulmonary edema, cardiac dysfunction, impaired hemostasis, pancreatitis, and multiple organ failure. […] The composition of scorpion venom consists of different compounds of varying concentrations. The compounds consist of neurotoxins, cardiotoxin, nephrotoxin, hemolytic toxin, phosphodiesterases, phospholipase, histamine, serotonin, etc. Of these different toxins, the most important and most potent one is the neurotoxin concentration.

• #2

  https://www.saem.org/about-saem/academies-interest-groups-affiliates2/cdem/for-students/online-education/m4-curriculum/group-m4-environmental/scorpion-stings

  Centruroides exilicauda venom contains neurotoxin that increases sodium channel permeability resulting in sodium channel activation and cell membrane depolarization. This results in over-stimulation of sympathetic and parasympathetic nervous systems, causing excessive acetylcholine and catecholamine release. […] In the United States, Centruroides exilicauda stings are associated with major neurologic toxicity, especially in young children. Supportive care is the key component of management. Antivenom therapy with equine derived Fab fragments reduces the duration of symptoms. […] Most victims of Centruroides excilicauda scorpion bites can be managed with supportive care only, such as local wound care, tetanus prophylaxis, opioids for muscle pain, and benzodiazepines for neuromuscular symptoms.

• #3 SCORPION STING .pptx

  https://www.slideshare.net/slideshow/scorpion-sting-pptx-259451188/259451188

  1) Scorpion stings are a medical emergency in tropical countries, with the Indian red scorpion being the most poisonous species in India. […] 2) Scorpion venom contains toxins that cause an „autonomic storm” by stimulating the sympathetic nervous system, leading to symptoms like tachycardia, hypertension, and convulsions. […] 3) The scorpion venom is a water-soluble antigenic complex mixture of neurotoxin, cardiotoxin, nephrotoxin, hemolysins, phosphodiesterases, phospholipase, hyaluronidases, histamine, and other chemicals. […] 4) The primary target of scorpion venom is voltage-dependent sodium channels and potassium channels. […] 5) These toxins cause massive release of autonomic neuromuscular neurotransmitters such as acetylcholine, norepinephrine, epinephrine, aspartate, and glutamate and evoke an autonomic storm.

• #4 Scorpion sting – Wikipedia

  https://en.wikipedia.org/wiki/Scorpion_sting

  A scorpion sting is an injury caused by the stinger of a scorpion resulting in the medical condition known as scorpionism, which may vary in severity. […] In serious cases, scorpion stings may involve the envenomation of humans by toxic scorpions, which may result in extreme pain, serious illness, or even death depending on the toxicity of the venom. […] Envenomation of a human by a scorpion may affect the sympathetic or parasympathetic systems depending on the species of scorpion. Some of the more severe side effects include respiratory distress syndrome, pulmonary edema, cardiac dysfunction, impaired hemostasis, pancreatitis, and multiple organ failure. […] The composition of scorpion venom consists of different compounds of varying concentrations. The compounds consist of neurotoxins, cardiotoxin, nephrotoxin, hemolytic toxin, phosphodiesterases, phospholipase, histamine, serotonin, etc. Of these different toxins, the most important and most potent one is the neurotoxin concentration.

• #5 Scorpion Envenomation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/168230-overview

  The primary targets of scorpion venom are voltage-dependent ion channels, of which sodium channels are the best studied. Venom toxins alter these channels, leading to prolonged neuronal activity. Many end-organ effects are secondary to this excessive excitation. Autonomic excitation leads to cardiopulmonary effects observed after some scorpion envenomations. Somatic and cranial nerve hyperactivity results from neuromuscular overstimulation. Additionally, serotonin may be found in scorpion venom and is thought to contribute to the pain associated with scorpion envenomation. […] The most potent toxin is the neurotoxin, of which two classes exist. Both types of neurotoxin are heat-stable, have low molecular weight, and are responsible for causing cell impairment in nerves, muscles, and the heart by altering ion channel permeability.

• #6 Scorpion Envenomation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/168230-overview

  The long-chain polypeptide neurotoxin causes stabilization of voltage-dependent sodium channels in the open position, leading to continuous, prolonged, repetitive firing of the somatic, sympathetic, and parasympathetic neurons. This repetitive firing results in autonomic and neuromuscular overexcitation symptoms, and it prevents normal nerve impulse transmissions. Furthermore, it results in release of excessive neurotransmitters such as epinephrine, norepinephrine, acetylcholine, glutamate, and aspartate. Meanwhile, the short polypeptide neurotoxin blocks the potassium channels. […] The binding of these neurotoxins to the host is reversible, but different neurotoxins have different affinities. The stability of the neurotoxin is due to the 4 disulfide bridges that fold the neurotoxin into a very compact 3-dimensional structure, thus making it resistant to pH and temperature changes. However, reagents that can break the disulfide bridges can inactivate this toxin by causing it to unfold. Also, the antigenicity of this toxin is dependent on the length and number of exposed regions that are sticking out of the 3-dimensional structure.

• #7 Scorpion Envenomation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/168230-overview

  The long-chain polypeptide neurotoxin causes stabilization of voltage-dependent sodium channels in the open position, leading to continuous, prolonged, repetitive firing of the somatic, sympathetic, and parasympathetic neurons. This repetitive firing results in autonomic and neuromuscular overexcitation symptoms, and it prevents normal nerve impulse transmissions. Furthermore, it results in release of excessive neurotransmitters such as epinephrine, norepinephrine, acetylcholine, glutamate, and aspartate. Meanwhile, the short polypeptide neurotoxin blocks the potassium channels. […] The binding of these neurotoxins to the host is reversible, but different neurotoxins have different affinities. The stability of the neurotoxin is due to the 4 disulfide bridges that fold the neurotoxin into a very compact 3-dimensional structure, thus making it resistant to pH and temperature changes. However, reagents that can break the disulfide bridges can inactivate this toxin by causing it to unfold. Also, the antigenicity of this toxin is dependent on the length and number of exposed regions that are sticking out of the 3-dimensional structure.

• #8 SciELO Brasil – Clinical update on scorpion envenoming Clinical update on scorpion envenoming

  https://www.scielo.br/j/rsbmt/a/C6vMnTMvwrwXmBSWjySsVYm/

  Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a significant public health problem globally. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy. […] The venom of Buthidae family scorpions contains several low-molecular weight proteins (neurotoxins) that act mainly on two classes of ion channels: the sodium (Na +) and potassium (K +) voltage-gated channels. These channels conduct the electrical impulse in most excitable tissues, promoting permeability to ions, which initiates the action potential. Alpha and beta toxins act on Na + channels at two pharmacologically distinct sites: alpha toxins bind to receptor site-4 and inhibit channel inactivation while the beta toxins bind receptor-type 3 and enhance activation of the channel upon subsequent depolarization. Toxins acting on K + channels physically block them, and prevent ionic conduction, thus prolonging the action potential. Therefore, the Na + and K + channel toxins synergize to cause intense and prolonged depolarization, leading to neuronal excitation. This in turn stimulates postganglionary nerve endings of the sympathetic and parasympathetic nervous system and of the adrenal medulla, inducing the release of acetylcholine, adrenaline, and noradrenaline. These mediators act rapidly after the sting to initiate a chain of events that represents scorpion envenoming, triggering the onset of clinical manifestations in practically all systems of the organism.

• #9 Tityustoxin – Wikipedia

  https://en.wikipedia.org/wiki/Tityustoxin

  Tityustoxin is a toxin found in the venom of scorpions from the subfamily Tityinae. By binding to voltage-dependent sodium ion channels and potassium channels, they cause sialorrhea, lacrimation and rhinorrhea. […] Two types of toxins are considered to be responsible for the main toxic effect: toxin gamma (a -type toxin) and tityustoxin (TsTX, an -type toxin), both with a specific affinity to the sodium channel. […] Tityustoxin causes cell depolarization, activating Na+ channels and increasing the Na+ uptake that can affect Ca2+ uptake and can increase acetylcholine (ACh) release from cerebral cortical slices. […] The -toxins bind to the subunit 3 of the sodium channel, slowing the inactivation and increasing peak current without changing time to peak. […] TsTX-I, Ts1 or toxin gamma is a -type toxin that binds to receptor site 4 and shift the voltage dependence of the sodium channel activation to more negative potentials.

• #10 Scorpion Envenomation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/168230-overview

  The long-chain polypeptide neurotoxin causes stabilization of voltage-dependent sodium channels in the open position, leading to continuous, prolonged, repetitive firing of the somatic, sympathetic, and parasympathetic neurons. This repetitive firing results in autonomic and neuromuscular overexcitation symptoms, and it prevents normal nerve impulse transmissions. Furthermore, it results in release of excessive neurotransmitters such as epinephrine, norepinephrine, acetylcholine, glutamate, and aspartate. Meanwhile, the short polypeptide neurotoxin blocks the potassium channels. […] The binding of these neurotoxins to the host is reversible, but different neurotoxins have different affinities. The stability of the neurotoxin is due to the 4 disulfide bridges that fold the neurotoxin into a very compact 3-dimensional structure, thus making it resistant to pH and temperature changes. However, reagents that can break the disulfide bridges can inactivate this toxin by causing it to unfold. Also, the antigenicity of this toxin is dependent on the length and number of exposed regions that are sticking out of the 3-dimensional structure.

• #11 Scorpion Envenomation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/168230-overview

  The long-chain polypeptide neurotoxin causes stabilization of voltage-dependent sodium channels in the open position, leading to continuous, prolonged, repetitive firing of the somatic, sympathetic, and parasympathetic neurons. This repetitive firing results in autonomic and neuromuscular overexcitation symptoms, and it prevents normal nerve impulse transmissions. Furthermore, it results in release of excessive neurotransmitters such as epinephrine, norepinephrine, acetylcholine, glutamate, and aspartate. Meanwhile, the short polypeptide neurotoxin blocks the potassium channels. […] The binding of these neurotoxins to the host is reversible, but different neurotoxins have different affinities. The stability of the neurotoxin is due to the 4 disulfide bridges that fold the neurotoxin into a very compact 3-dimensional structure, thus making it resistant to pH and temperature changes. However, reagents that can break the disulfide bridges can inactivate this toxin by causing it to unfold. Also, the antigenicity of this toxin is dependent on the length and number of exposed regions that are sticking out of the 3-dimensional structure.

• #12 Scorpion Envenomation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/168230-overview

  The long-chain polypeptide neurotoxin causes stabilization of voltage-dependent sodium channels in the open position, leading to continuous, prolonged, repetitive firing of the somatic, sympathetic, and parasympathetic neurons. This repetitive firing results in autonomic and neuromuscular overexcitation symptoms, and it prevents normal nerve impulse transmissions. Furthermore, it results in release of excessive neurotransmitters such as epinephrine, norepinephrine, acetylcholine, glutamate, and aspartate. Meanwhile, the short polypeptide neurotoxin blocks the potassium channels. […] The binding of these neurotoxins to the host is reversible, but different neurotoxins have different affinities. The stability of the neurotoxin is due to the 4 disulfide bridges that fold the neurotoxin into a very compact 3-dimensional structure, thus making it resistant to pH and temperature changes. However, reagents that can break the disulfide bridges can inactivate this toxin by causing it to unfold. Also, the antigenicity of this toxin is dependent on the length and number of exposed regions that are sticking out of the 3-dimensional structure.

• #13 Scorpion Venom Has A Secret Ingredient: Acid | Discover Magazine

  https://www.discovermagazine.com/planet-earth/scorpion-venom-has-a-secret-ingredient-acid

  A scorpions sting doesnt just impart venom it uses a special acid to bring the pain. […] The venom targets several pain receptors to warn away would-be predators, and it uses acid to make the sting all the more excruciating. […] The venom activates the TRPV1 channel in our bodies, the same receptor responsible for the burning and tingling when you eat a hot pepper. […] To truly bring the pain, the venom must first alter the environment surrounding the neuron itself, effectively priming it to relay as much pain as possible. […] A lot of venomous animals snakes, scorpions, spiders when they deliver that venom, that venom is quite acidic. […] Acids contain a high concentration of protons, which bind to neurons and increase the intensity of the signals they transmit. […] The venom is already primed to spark pain the acid helps by forcing open the ion channels that allow neurons to communicate with each other. […] When we have the two together in combination, they can activate the channel very well. […] The research is important in understanding how the body regulates temperature as well, as TVP1 is also a temperature sensor in the body.

• #14 Scorpion Venom Has A Secret Ingredient: Acid | Discover Magazine

  https://www.discovermagazine.com/planet-earth/scorpion-venom-has-a-secret-ingredient-acid

  A scorpions sting doesnt just impart venom it uses a special acid to bring the pain. […] The venom targets several pain receptors to warn away would-be predators, and it uses acid to make the sting all the more excruciating. […] The venom activates the TRPV1 channel in our bodies, the same receptor responsible for the burning and tingling when you eat a hot pepper. […] To truly bring the pain, the venom must first alter the environment surrounding the neuron itself, effectively priming it to relay as much pain as possible. […] A lot of venomous animals snakes, scorpions, spiders when they deliver that venom, that venom is quite acidic. […] Acids contain a high concentration of protons, which bind to neurons and increase the intensity of the signals they transmit. […] The venom is already primed to spark pain the acid helps by forcing open the ion channels that allow neurons to communicate with each other. […] When we have the two together in combination, they can activate the channel very well. […] The research is important in understanding how the body regulates temperature as well, as TVP1 is also a temperature sensor in the body.

• #15 Why Scorpion Stings Deliver an Insufferable Pain—-Chinese Academy of Sciences

  https://english.cas.cn/newsroom/archive/research_archive/rp2017/201708/t20170803_181736.shtml

  Scorpion stings are well known to be extremely painful, however, why scorpion stings produce an insufferable pain remains unknown worldwide due to the lack of understanding of molecular base. […] A recent study conducted by LAI Ren and his colleagues at Kunming Institute of Zoology of Chinese Academy of Sciences, UC Davis in USA and Zhejiang University revealed this molecular mechanism, and the results were published in Science Advances. […] Like tasting red chili pepper, scorpion toxin BmP01, a 29-amino acid peptide, can activate capsaicin receptor (TRPV1) and induce burning pain. […] However, BmP01-induced TRPV1 activation is highly acid related and acts as a one-two punch mechanism. […] Researchers suggested the functional and evolutionary importance of the venom acidity in scorpion toxin-induced pain. These data also offered some clues for clinical treatment of scorpion stings.

• #16 Scorpion Venom Has A Secret Ingredient: Acid | Discover Magazine

  https://www.discovermagazine.com/planet-earth/scorpion-venom-has-a-secret-ingredient-acid

  A scorpions sting doesnt just impart venom it uses a special acid to bring the pain. […] The venom targets several pain receptors to warn away would-be predators, and it uses acid to make the sting all the more excruciating. […] The venom activates the TRPV1 channel in our bodies, the same receptor responsible for the burning and tingling when you eat a hot pepper. […] To truly bring the pain, the venom must first alter the environment surrounding the neuron itself, effectively priming it to relay as much pain as possible. […] A lot of venomous animals snakes, scorpions, spiders when they deliver that venom, that venom is quite acidic. […] Acids contain a high concentration of protons, which bind to neurons and increase the intensity of the signals they transmit. […] The venom is already primed to spark pain the acid helps by forcing open the ion channels that allow neurons to communicate with each other. […] When we have the two together in combination, they can activate the channel very well. […] The research is important in understanding how the body regulates temperature as well, as TVP1 is also a temperature sensor in the body.

• #17 Scorpion Venom Has A Secret Ingredient: Acid | Discover Magazine

  https://www.discovermagazine.com/planet-earth/scorpion-venom-has-a-secret-ingredient-acid

  A scorpions sting doesnt just impart venom it uses a special acid to bring the pain. […] The venom targets several pain receptors to warn away would-be predators, and it uses acid to make the sting all the more excruciating. […] The venom activates the TRPV1 channel in our bodies, the same receptor responsible for the burning and tingling when you eat a hot pepper. […] To truly bring the pain, the venom must first alter the environment surrounding the neuron itself, effectively priming it to relay as much pain as possible. […] A lot of venomous animals snakes, scorpions, spiders when they deliver that venom, that venom is quite acidic. […] Acids contain a high concentration of protons, which bind to neurons and increase the intensity of the signals they transmit. […] The venom is already primed to spark pain the acid helps by forcing open the ion channels that allow neurons to communicate with each other. […] When we have the two together in combination, they can activate the channel very well. […] The research is important in understanding how the body regulates temperature as well, as TVP1 is also a temperature sensor in the body.

• #18 Scorpion Venom Has A Secret Ingredient: Acid | Discover Magazine

  https://www.discovermagazine.com/planet-earth/scorpion-venom-has-a-secret-ingredient-acid

  A scorpions sting doesnt just impart venom it uses a special acid to bring the pain. […] The venom targets several pain receptors to warn away would-be predators, and it uses acid to make the sting all the more excruciating. […] The venom activates the TRPV1 channel in our bodies, the same receptor responsible for the burning and tingling when you eat a hot pepper. […] To truly bring the pain, the venom must first alter the environment surrounding the neuron itself, effectively priming it to relay as much pain as possible. […] A lot of venomous animals snakes, scorpions, spiders when they deliver that venom, that venom is quite acidic. […] Acids contain a high concentration of protons, which bind to neurons and increase the intensity of the signals they transmit. […] The venom is already primed to spark pain the acid helps by forcing open the ion channels that allow neurons to communicate with each other. […] When we have the two together in combination, they can activate the channel very well. […] The research is important in understanding how the body regulates temperature as well, as TVP1 is also a temperature sensor in the body.

• #19 Why scorpion stings are so painful

  https://phys.org/news/2017-08-scorpion-painful.html

  A combined team of researchers from the U.S. and China has figured out why scorpion stings are so painful. In their paper published on the open access site Science Advances, the team explains how scorpion venom containing a variety of toxins and is mildly acidic, causing a lot of pain. […] They focused on a peptide called BmP01, previously identified as the most likely pain-causing ingredient in the fluid mixture of more than 100 toxins. […] To find out what might be boosting its pain potential, the researchers looked at other ingredients and characteristics of the venom. […] They noticed that the venom was mildly acidic. Looking even closer, they found that BmP01 tends to bind with proton-binding sites on TRPV1. Also, more importantly, the acid in the venom resulted in donations of protons that worked with BmP01 to heighten the amount of pain it could cause. Together, the researchers found, the two were able to unlock the gate that led to the TRPV1 pathway, which allowed more pain signals to pass through. That meant that the pain signals generated by the introduction of BmP01 into the body were magnified due to the acidity of the venom.

• #20 Scorpions | Ask A Biologist

  https://askabiologist.asu.edu/explore/not-so-scary-scorpions

  Scorpions are amazing animals, but they can pack a painful sting. […] Scorpions are nocturnal predators. Hunting at night, a scorpion will eat almost anything, even other scorpions. After an unlucky animal is grabbed by a scorpion’s strong pincers, the scorpion uses its stinger to sting the animal multiple times. […] Research on some scorpions has shown that they have two types of venom. One is good for killing prey and the other is better for stunning or just warning other creatures away, like you and me. […] If you think a scorpion has stung you there are a few symptoms to watch out for. Symptoms include: local pain where stung but no swelling; touching the area is painful; numbness and tingling in parts of the body distant from the sting; trouble focusing eyes or random eye movements; trouble swallowing, drooling and the tongue feels swollen; slurred speech; young children may rub their faces which may indicate facial numbness; muscle twitching; and restlessness, irritability, or hyperactivity.

• #21 Scorpions | Ask A Biologist

  https://askabiologist.asu.edu/explore/not-so-scary-scorpions

  Scorpions are amazing animals, but they can pack a painful sting. […] Scorpions are nocturnal predators. Hunting at night, a scorpion will eat almost anything, even other scorpions. After an unlucky animal is grabbed by a scorpion’s strong pincers, the scorpion uses its stinger to sting the animal multiple times. […] Research on some scorpions has shown that they have two types of venom. One is good for killing prey and the other is better for stunning or just warning other creatures away, like you and me. […] If you think a scorpion has stung you there are a few symptoms to watch out for. Symptoms include: local pain where stung but no swelling; touching the area is painful; numbness and tingling in parts of the body distant from the sting; trouble focusing eyes or random eye movements; trouble swallowing, drooling and the tongue feels swollen; slurred speech; young children may rub their faces which may indicate facial numbness; muscle twitching; and restlessness, irritability, or hyperactivity.

• #22 How Does a Scorpion Decide When to Sting? – JSTOR Daily

  https://daily.jstor.org/how-does-a-scorpion-decide-when-to-sting/

  Scorpions face a serious dilemma when it comes to both hunting and defense. Their venom is by far their most effective weapon, and may well be the secret to their success in colonizing a wide variety of habitats across most continents. However, venom is metabolically expensive to produce, and evidence shows that scorpions would rather conserve venom if they can to save the energy needed to make more. Consequently scorpions tend to reserve their use of venom for hunting larger prey and defending themselves against predators. […] It turns out that there are degrees of venom. The very first little bit of venom is clear, compared to the thicker, more viscous and opaque venom that immediately follows. Inceoglu et. al. dubbed the clear droplet prevenom, and decided to analyze its properties. […] What they found is that the prevenom is nasty stuff, but not nearly as nasty as full-fledged venom. Prevenom contains a lot of potassium ions. A high concentration of potassium outside nerve cells can cause those ions to enter the cell, instigating depolarization, which is the major step in conducting the electrical charge, aka the nerve impulses. The sudden firing of neurons can be very painful, but worse, from the perspective of the scorpions prey, the prevenom contains substances that block the channels transporting potassium ions back out of the cell. After a sting, the nerve cells are unable to reset, as it were, to their resting state. Smaller prey are thus paralyzed by the prevenom. (Theyre easier to eat when theyre still.)

• #23 How Does a Scorpion Decide When to Sting? – JSTOR Daily

  https://daily.jstor.org/how-does-a-scorpion-decide-when-to-sting/

  Scorpions face a serious dilemma when it comes to both hunting and defense. Their venom is by far their most effective weapon, and may well be the secret to their success in colonizing a wide variety of habitats across most continents. However, venom is metabolically expensive to produce, and evidence shows that scorpions would rather conserve venom if they can to save the energy needed to make more. Consequently scorpions tend to reserve their use of venom for hunting larger prey and defending themselves against predators. […] It turns out that there are degrees of venom. The very first little bit of venom is clear, compared to the thicker, more viscous and opaque venom that immediately follows. Inceoglu et. al. dubbed the clear droplet prevenom, and decided to analyze its properties. […] What they found is that the prevenom is nasty stuff, but not nearly as nasty as full-fledged venom. Prevenom contains a lot of potassium ions. A high concentration of potassium outside nerve cells can cause those ions to enter the cell, instigating depolarization, which is the major step in conducting the electrical charge, aka the nerve impulses. The sudden firing of neurons can be very painful, but worse, from the perspective of the scorpions prey, the prevenom contains substances that block the channels transporting potassium ions back out of the cell. After a sting, the nerve cells are unable to reset, as it were, to their resting state. Smaller prey are thus paralyzed by the prevenom. (Theyre easier to eat when theyre still.)

• #24 How Does a Scorpion Decide When to Sting? – JSTOR Daily

  https://daily.jstor.org/how-does-a-scorpion-decide-when-to-sting/

  Full venom has a similar mechanism, also affecting nerve impulses. However, full venom works at much lower doses than prevenom. Where prevenom mostly contains salts, the full venom has a much higher concentration of proteins. These proteins are potent toxins that can affect impulses in the heart and blood vessels, resulting in a massive crash in blood pressure and possibly death. […] So it seems scorpions face a more sophisticated range of choices than simply stinging or not. There are two decisions to make: whether to sting at all and whether to use prevenom or full venom. […] For smaller prey, scorpions may not sting at all or they may simply paralyze the prey with prevenom so theyre easier to eat. For larger predators, some kind of sting is needed. They can use prevenom for deterrence and conserve energy, or if the situation is dire, they can deliver the full venom. Large predators arent paralyzed, but they suffer agonizing pain.

• #25 How Does a Scorpion Decide When to Sting? – JSTOR Daily

  https://daily.jstor.org/how-does-a-scorpion-decide-when-to-sting/

  Full venom has a similar mechanism, also affecting nerve impulses. However, full venom works at much lower doses than prevenom. Where prevenom mostly contains salts, the full venom has a much higher concentration of proteins. These proteins are potent toxins that can affect impulses in the heart and blood vessels, resulting in a massive crash in blood pressure and possibly death. […] So it seems scorpions face a more sophisticated range of choices than simply stinging or not. There are two decisions to make: whether to sting at all and whether to use prevenom or full venom. […] For smaller prey, scorpions may not sting at all or they may simply paralyze the prey with prevenom so theyre easier to eat. For larger predators, some kind of sting is needed. They can use prevenom for deterrence and conserve energy, or if the situation is dire, they can deliver the full venom. Large predators arent paralyzed, but they suffer agonizing pain.

• #26 Scorpion Venom and the Inflammatory Response

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2838227/

  The cytokines initiate a cascade of events that lead to illness behaviors such as fever, anorexia, and also physiological events in the host such as activation of vasodilatation, hypotension, and increased of vessel permeability. […] The signs of the scorpion envenomation are determined by the symptoms presented by victims of scorpion envenomation are usually complex in nature and can be attributed mainly to hyperactivity of the autonomic nervous system. […] The venom contain neurotoxic peptides which are responsible for the symptoms that present during envenomation by interacting with ion channels and have the potential to cause massive damage to nervous system of both vertebrates and invertebrates. […] The neurotoxic peptides and small proteins lead to dysfunction and provoke pathophysiological actions, such as membrane destabilization, blocking of the central, and peripheral nervous systems or alteration of smooth or skeletal muscle activity.

• #27 Scorpion sting | PPT

  https://www.slideshare.net/ikramdr01/scorpion-sting-173277069

  Sodium and potassium channel blocking toxins of scorpion venom mediate synergistic effects responsible for intense and persistent depolarization of autonomic nerves with massive release of autonomic neurotransmitters evokes an autonomic storm response. […] The stimulation of nitrergic nerves supplying penile smooth muscles may explain the priapism observed in severe scorpion envenoming. […] Scorpion venom contains serotonin, which may cause local pain at the site of sting. […] Clinical presentation can be divided into local manifestations and systemic manifestations. 1) Local Manifestations Severe excruciating local pain is the only clinical manifestation seen in 35% of cases, radiating along the corresponding dermatomes. […] 2) Systemic Manifestations Scorpion venom delays the closing of neuronal sodium channels, resulting in autonomic storm owing to sudden outpouring of endogenous catecholamines into the circulation. Systemic symptoms may develop within minutes, but may be delayed as much as 24 hours.

• #28 Scorpion sting | PPT

  https://www.slideshare.net/ikramdr01/scorpion-sting-173277069

  Sodium and potassium channel blocking toxins of scorpion venom mediate synergistic effects responsible for intense and persistent depolarization of autonomic nerves with massive release of autonomic neurotransmitters evokes an autonomic storm response. […] The stimulation of nitrergic nerves supplying penile smooth muscles may explain the priapism observed in severe scorpion envenoming. […] Scorpion venom contains serotonin, which may cause local pain at the site of sting. […] Clinical presentation can be divided into local manifestations and systemic manifestations. 1) Local Manifestations Severe excruciating local pain is the only clinical manifestation seen in 35% of cases, radiating along the corresponding dermatomes. […] 2) Systemic Manifestations Scorpion venom delays the closing of neuronal sodium channels, resulting in autonomic storm owing to sudden outpouring of endogenous catecholamines into the circulation. Systemic symptoms may develop within minutes, but may be delayed as much as 24 hours.

• #29 Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial | The BMJ

  https://www.bmj.com/content/342/bmj.c7136

  Scorpion sting can pose a life threatening acute medical emergency and is a neglected public health problem in tropical and sub-tropical countries, especially in North Africa, the Middle East, Latin America, and India. Mesobuthus tamulus, an Indian red scorpion, is the most lethal species of the Buthidae family in India. Its venom delays the closing of neuronal sodium channels, resulting in autonomic storm owing to sudden pouring of endogenous catecholamine into the circulation. Autonomic storm is characterised by transient parasympathetic and prolonged sympathetic stimulation. Morbidity and mortality due to scorpion sting result from acute refractory pulmonary oedema, cardiogenic shock, and multiorgan failure. Opinions differ about the correct treatment for scorpion sting. In the past various regimens, including a lytic cocktail, insulin, atropine, blocker, nifedipine, and captopril have failed to reduce morbidity and mortality, but since the advent of the 1 blocker prazosin the fatality rate has been reduced to 1%.

• #30 Clinical features and outcomes of scorpion sting in western lowland of Eritrea: a prospective descriptive study | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.01.02.24300701v1.full

  Scorpion venom is a cocktail of complex structures formed by neurotoxic proteins, acidic proteins, salts, and organic compounds, with variable compositions and lethality amongst subspecies. Venom mainly effects neurologic, cardiovascular, respiratory, hematologic, and renal systems with local effects around the sting site (i.e. redness, pain, swelling, and burning). […] Toxins and enzymes within venom possess neurological tropism effects that act mainly on voltage-gated sodium and potassium ion channels on excitable cells of nerves and muscles. Venom from the same scorpion can have multiple toxins that can interact with each other, modulating the response of the ion channels involved and leading to complex, rapidly progressive symptoms. […] The main effect of the venom in a victim is to mediate ion channels for intense, persistent depolarization of autonomic nerves, leading to massive discharges of neurotransmitters from both autonomic nervous system branches. This is referred to as an autonomic storm owing to the sudden pouring of endogenous catecholamine into the circulation.

• #31 Clinical features and outcomes of scorpion sting in western lowland of Eritrea: a prospective descriptive study | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.01.02.24300701v1.full

  The effects of an autonomic storm are seen throughout the body, but are more serious on the cardiovascular and respiratory systems leading to arrhythmia, hypertension or hypotension, and pulmonary edema. […] Clinically, the autonomic storm evoked due to scorpion envenoming is characterized by transient parasympathetic (vomiting, profuse sweating, ropy salivation, bradycardia, ventricular premature contraction, priapism in male, and hypotension) and prolonged sympathetic (cold extremities, hypertension, tachycardia, pulmonary edema, and shock) stimulation. […] A critical component of scorpion sting pathogenesis is alpha-receptor stimulation. […] Prazosin is an 1-blocker commonly known as a pharmacological and physiological antidote to the venom action. The drug acts to relieve serious breathing difficulty due to high blood pressure.

• #32 SCORPION STING .pptx

  https://www.slideshare.net/slideshow/scorpion-sting-pptx-259451188/259451188

  6) Sympathetic system stimulation leads to increased levels of catecholamines, resulting in adrenergic storm which manifests as tachycardia, hypertension, diaphoresis, hyperthermia, hyperglycemia, urinary retention, tachypnea, mydriasis, tremor, and convulsions. […] 7) In contrast, parasympathetic nervous system stimulation leads to muscarinic response manifesting as salivation, sweating, vomiting, urinary incontinence, bronchial hypersecretion, diarrhea, miosis, bronchospasm, bradycardia, hypotension as well as priapism in males. […] 8) Cardiovascular system initially, bradycardia occurs then tachycardia and hypotension, followed by hypertension. […] 9) Vasospasm and increased myocardial demand causes myocardial injury. […] 10) Cardiac dysfunction leads to acute pulmonary edema and is responsible for one-third of the fatalities.

• #33 SCORPION STING .pptx

  https://www.slideshare.net/slideshow/scorpion-sting-pptx-259451188/259451188

  6) Sympathetic system stimulation leads to increased levels of catecholamines, resulting in adrenergic storm which manifests as tachycardia, hypertension, diaphoresis, hyperthermia, hyperglycemia, urinary retention, tachypnea, mydriasis, tremor, and convulsions. […] 7) In contrast, parasympathetic nervous system stimulation leads to muscarinic response manifesting as salivation, sweating, vomiting, urinary incontinence, bronchial hypersecretion, diarrhea, miosis, bronchospasm, bradycardia, hypotension as well as priapism in males. […] 8) Cardiovascular system initially, bradycardia occurs then tachycardia and hypotension, followed by hypertension. […] 9) Vasospasm and increased myocardial demand causes myocardial injury. […] 10) Cardiac dysfunction leads to acute pulmonary edema and is responsible for one-third of the fatalities.

• #34 Scorpion Envenomation: Background, Pathophysiology, Etiology

  https://emedicine.medscape.com/article/168230-overview

  The long-chain polypeptide neurotoxin causes stabilization of voltage-dependent sodium channels in the open position, leading to continuous, prolonged, repetitive firing of the somatic, sympathetic, and parasympathetic neurons. This repetitive firing results in autonomic and neuromuscular overexcitation symptoms, and it prevents normal nerve impulse transmissions. Furthermore, it results in release of excessive neurotransmitters such as epinephrine, norepinephrine, acetylcholine, glutamate, and aspartate. Meanwhile, the short polypeptide neurotoxin blocks the potassium channels. […] The binding of these neurotoxins to the host is reversible, but different neurotoxins have different affinities. The stability of the neurotoxin is due to the 4 disulfide bridges that fold the neurotoxin into a very compact 3-dimensional structure, thus making it resistant to pH and temperature changes. However, reagents that can break the disulfide bridges can inactivate this toxin by causing it to unfold. Also, the antigenicity of this toxin is dependent on the length and number of exposed regions that are sticking out of the 3-dimensional structure.

• #35 Efficacy and safety of scorpion antivenom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label clinical trial | The BMJ

  https://www.bmj.com/content/342/bmj.c7136

  Scorpion venom evokes transient parasympathetic and prolonged sympathetic stimulation. The presence of clinical signs and symptoms of excess acetylcholine indicate the presence of active free circulating venom in the blood, which can be neutralised by antivenom. The sympathetic signs suggest after effects of venom on the sympathetic system, which are unresponsive to antivenom but reversible with prazosin. Moreover morbidity and mortality due to envenoming are caused by sympathetic overstimulation and not parasympathetic stimulation. Thus, early administration of antivenom in a stage of acetylcholine excess and prazosin to counteract the sympathetic and metabolic effects may be synergistic in enhancing recovery. […] Total doses of prazosin required were significantly lower in the antivenom plus prazosin group than in the prazosin alone group, suggesting that timely administration of scorpion antivenom leads to rapid neutralisation of circulating venom, resulting in minimum venom available for neuronal sodium channel activation. Amelioration of parasympathetic stimulation (sweating, salivation, arrhythmias) by antivenom may have accounted for the lower incidence of hypotension in the antivenom plus prazosin group.

• #36 Indian Pediatrics – Editorial

  https://www.indianpediatrics.net/may2000/may-504-514.htm

  Scorpion sting is an acute life-threatening, time-limiting medical emergency of villagers. […] Case fatality rates of 3-22% were reported among children hospitalized for scorpion stings in India, Saudi Arabia and South Africa. […] Cardiovascular effects are particularly prominent following the stings by Indian red scorpion (Mesobuthus tamulus). […] Various reports on clinical effects, bio-chemistry of scorpion venom, extrapolation of animal studies to clinical setting, autopsy studies and therapeutic interventions have contributed to our understanding of scorpion envenomation. […] Scorpion venoms are species-specific complex mixtures of short neurotoxic proteins. […] Voltage dependant ion channels are altered by the venom. […] Alpha receptors stimulation by the toxin plays a major role, resulting in hypertension, tachycardia, myocardial dysfunction, pulmonary edema and cool extremities.

• #37 Clinical features and outcomes of scorpion sting in western lowland of Eritrea: a prospective descriptive study | medRxiv

  https://www.medrxiv.org/content/10.1101/2024.01.02.24300701v1.full

  The effects of an autonomic storm are seen throughout the body, but are more serious on the cardiovascular and respiratory systems leading to arrhythmia, hypertension or hypotension, and pulmonary edema. […] Clinically, the autonomic storm evoked due to scorpion envenoming is characterized by transient parasympathetic (vomiting, profuse sweating, ropy salivation, bradycardia, ventricular premature contraction, priapism in male, and hypotension) and prolonged sympathetic (cold extremities, hypertension, tachycardia, pulmonary edema, and shock) stimulation. […] A critical component of scorpion sting pathogenesis is alpha-receptor stimulation. […] Prazosin is an 1-blocker commonly known as a pharmacological and physiological antidote to the venom action. The drug acts to relieve serious breathing difficulty due to high blood pressure.

• #38 SciELO Brasil – Clinical update on scorpion envenoming Clinical update on scorpion envenoming

  https://www.scielo.br/j/rsbmt/a/C6vMnTMvwrwXmBSWjySsVYm/

  Cardiac involvement, usually reversible within the first week post-sting, has been mainly attributed to the adrenergic firing induced by the scorpion toxin. Catecholamine-mediated cardiac damage seems to be multifactorial and may be attributed to the relative hypoxia caused by the increase in heart rate, or by coronary spasm and vasoconstriction of the microcirculation, in addition to a direct toxic effect of these mediators on myocardial cells through the increase in intracellular calcium. Elevated levels of proinflammatory cytokines and the neuropeptides endothelin-1 and neuropeptide Y detected in scorpion envenoming may also potentiate myocardial dysfunction through their direct depressive effect on contractile cardiac function and by mediating coronary constriction. […] The cardiac involvement observed manifests clinically mainly as a reversible acute left ventricle (LV) dysfunction of different degrees of severity, with altered global or regional mobility occurring soon after the sting, and possible progression to acute pulmonary edema. It is accompanied by increased serum levels of cardiac markers, as well as by changes in the electrocardiogram (ECG) and echocardiogram (ECHO) readouts. Another characteristic of the cardiac dysfunction mediated by catecholamine concerns the ECHO, whose findings do not follow the anatomic distribution of the coronary arteries.

• #39 SciELO Brasil – Clinical update on scorpion envenoming Clinical update on scorpion envenoming

  https://www.scielo.br/j/rsbmt/a/C6vMnTMvwrwXmBSWjySsVYm/

  Cardiac involvement, usually reversible within the first week post-sting, has been mainly attributed to the adrenergic firing induced by the scorpion toxin. Catecholamine-mediated cardiac damage seems to be multifactorial and may be attributed to the relative hypoxia caused by the increase in heart rate, or by coronary spasm and vasoconstriction of the microcirculation, in addition to a direct toxic effect of these mediators on myocardial cells through the increase in intracellular calcium. Elevated levels of proinflammatory cytokines and the neuropeptides endothelin-1 and neuropeptide Y detected in scorpion envenoming may also potentiate myocardial dysfunction through their direct depressive effect on contractile cardiac function and by mediating coronary constriction. […] The cardiac involvement observed manifests clinically mainly as a reversible acute left ventricle (LV) dysfunction of different degrees of severity, with altered global or regional mobility occurring soon after the sting, and possible progression to acute pulmonary edema. It is accompanied by increased serum levels of cardiac markers, as well as by changes in the electrocardiogram (ECG) and echocardiogram (ECHO) readouts. Another characteristic of the cardiac dysfunction mediated by catecholamine concerns the ECHO, whose findings do not follow the anatomic distribution of the coronary arteries.

• #40 Scorpion envenomation-associated myocarditis: A systematic review | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0011219

  Scorpion envenomation is associated with several complications. One of the most serious complications is the cardiac involvement in the form of myocarditis that remains the main reason for mortalities associated with scorpion envenomation. […] The mechanism by which scorpion envenomation causes myocarditis has been mainly associated with the release of catecholamines and vasoactive peptides. Scorpion venoms neurotoxins affect voltage-gated sodium (Na) and potassium (K) channels leading to neuronal excitation and release of a large quantity of acetylcholine, epinephrine, and norepinephrine from the sympathetic and parasympathetic nerve endings and adrenal medulla. […] The mortality associated with scorpion envenomation is mainly due to myocarditis and acute pulmonary edema. […] Myocardial damage is caused by a complex interplay of hemodynamic, metabolic, and myocardial variables; as a result, it is difficult to pinpoint the specific mechanism of venom’s effect on the heart.

• #41 Scorpion envenomation-associated myocarditis: A systematic review | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0011219

  Scorpion-related cardiac damage has been histopathologically proven to be actual myocarditis; inflammatory infiltrates, necrosis, and tissue edema observed in pathological investigations is compatible with histological findings of myocarditis. […] The mainstay of scorpion-related myocarditis management is anti-heart failure treatment. The use of inotropes and diuretics suggested by guidelines in intensive care units with respiratory and mechanical cardiopulmonary support facilities is recommended. […] Myocarditis associated with scorpion envenomation is a rare but potentially devastating complication of scorpion stings which is more common in children. Although scorpion envenomation usually causes mild to moderate symptoms, myocarditis should remain on the list of differential diagnoses in the case of cardiopulmonary presentations.

• #42 SciELO Brasil – Clinical update on scorpion envenoming Clinical update on scorpion envenoming

  https://www.scielo.br/j/rsbmt/a/C6vMnTMvwrwXmBSWjySsVYm/

  Cardiac involvement, usually reversible within the first week post-sting, has been mainly attributed to the adrenergic firing induced by the scorpion toxin. Catecholamine-mediated cardiac damage seems to be multifactorial and may be attributed to the relative hypoxia caused by the increase in heart rate, or by coronary spasm and vasoconstriction of the microcirculation, in addition to a direct toxic effect of these mediators on myocardial cells through the increase in intracellular calcium. Elevated levels of proinflammatory cytokines and the neuropeptides endothelin-1 and neuropeptide Y detected in scorpion envenoming may also potentiate myocardial dysfunction through their direct depressive effect on contractile cardiac function and by mediating coronary constriction. […] The cardiac involvement observed manifests clinically mainly as a reversible acute left ventricle (LV) dysfunction of different degrees of severity, with altered global or regional mobility occurring soon after the sting, and possible progression to acute pulmonary edema. It is accompanied by increased serum levels of cardiac markers, as well as by changes in the electrocardiogram (ECG) and echocardiogram (ECHO) readouts. Another characteristic of the cardiac dysfunction mediated by catecholamine concerns the ECHO, whose findings do not follow the anatomic distribution of the coronary arteries.

• #43 Scorpion envenomation-associated myocarditis: A systematic review | PLOS Neglected Tropical Diseases

  https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0011219

  Scorpion-related cardiac damage has been histopathologically proven to be actual myocarditis; inflammatory infiltrates, necrosis, and tissue edema observed in pathological investigations is compatible with histological findings of myocarditis. […] The mainstay of scorpion-related myocarditis management is anti-heart failure treatment. The use of inotropes and diuretics suggested by guidelines in intensive care units with respiratory and mechanical cardiopulmonary support facilities is recommended. […] Myocarditis associated with scorpion envenomation is a rare but potentially devastating complication of scorpion stings which is more common in children. Although scorpion envenomation usually causes mild to moderate symptoms, myocarditis should remain on the list of differential diagnoses in the case of cardiopulmonary presentations.

• #44 Indian Pediatrics – Editorial

  https://www.indianpediatrics.net/may2000/may-504-514.htm

  The unopposed effects of alpha receptors stimulation lead to suppression of insulin secretion, hyperglycemia, hyperkalemia, free fatty acids and free radicals accumulation injurious to myocardium. […] Changes in blood coagulation profile and presence of acute disseminated intravascular coagulation (DIC) were observed in dogs after scorpion venom injection. […] Direct effect of toxins on neurons could contribute to seizures and encephalopathy in some children. […] Systemic inflammatory response like syndrome is triggered during envenomation caused by scorpion species Tityus serrulatus. […] Increased levels of Interleukin-6, IL-1a and IFN- gamma were seen in all patients. […] The role of i NOS in causing direct tissue injury due to scorpion venom deserves further study. […] Clinical acceptance of prazosin for scorpion sting now exists. […] The usefulness of prazosin therapy in this condition was scientifically established in mid-eighties in India. […] Since the use of prazosin (1984 onwards) the mortality in these victims is reduced to less than 1%.

• #45 Indian Pediatrics – Editorial

  https://www.indianpediatrics.net/may2000/may-504-514.htm

  The unopposed effects of alpha receptors stimulation lead to suppression of insulin secretion, hyperglycemia, hyperkalemia, free fatty acids and free radicals accumulation injurious to myocardium. […] Changes in blood coagulation profile and presence of acute disseminated intravascular coagulation (DIC) were observed in dogs after scorpion venom injection. […] Direct effect of toxins on neurons could contribute to seizures and encephalopathy in some children. […] Systemic inflammatory response like syndrome is triggered during envenomation caused by scorpion species Tityus serrulatus. […] Increased levels of Interleukin-6, IL-1a and IFN- gamma were seen in all patients. […] The role of i NOS in causing direct tissue injury due to scorpion venom deserves further study. […] Clinical acceptance of prazosin for scorpion sting now exists. […] The usefulness of prazosin therapy in this condition was scientifically established in mid-eighties in India. […] Since the use of prazosin (1984 onwards) the mortality in these victims is reduced to less than 1%.

• #46 Scorpion Venom and the Inflammatory Response

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2838227/

  The cytokines initiate a cascade of events that lead to illness behaviors such as fever, anorexia, and also physiological events in the host such as activation of vasodilatation, hypotension, and increased of vessel permeability. […] The signs of the scorpion envenomation are determined by the symptoms presented by victims of scorpion envenomation are usually complex in nature and can be attributed mainly to hyperactivity of the autonomic nervous system. […] The venom contain neurotoxic peptides which are responsible for the symptoms that present during envenomation by interacting with ion channels and have the potential to cause massive damage to nervous system of both vertebrates and invertebrates. […] The neurotoxic peptides and small proteins lead to dysfunction and provoke pathophysiological actions, such as membrane destabilization, blocking of the central, and peripheral nervous systems or alteration of smooth or skeletal muscle activity.

• #47 Scorpion Venom and the Inflammatory Response

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2838227/

  The pathophysiology of envenomation is complex, but there is little doubt that injection often progresses from systemic inflammatory response to severe envenomation. […] The production and/or release of cytokines may also play a role in the development of hyperglycemia, in particular TNF- has been demonstrated to induce insulin resistance in animals models. […] The pathogenesis of tissue injury is complex and cannot be attributed to a single agent. Tissue injury occurs during inflammation and is a progressive process which may eventually lead to organ dysfunction and failure. […] The balance between pro- and anti-inflammatory activities determines the degree and extent of inflammation, and thus can lead to different clinical effects. […] An excessive proinflammatory response is thought to be important in the pathogenesis of septic shock. […] In scorpion envenomation the balance between pro- and anti-inflammatory cytokines determines the degree and extent of inflammation, and thus can lead to different clinical effects.

• #48 Scorpion Venom and the Inflammatory Response

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2838227/

  The pathophysiology of envenomation is complex, but there is little doubt that injection often progresses from systemic inflammatory response to severe envenomation. […] The production and/or release of cytokines may also play a role in the development of hyperglycemia, in particular TNF- has been demonstrated to induce insulin resistance in animals models. […] The pathogenesis of tissue injury is complex and cannot be attributed to a single agent. Tissue injury occurs during inflammation and is a progressive process which may eventually lead to organ dysfunction and failure. […] The balance between pro- and anti-inflammatory activities determines the degree and extent of inflammation, and thus can lead to different clinical effects. […] An excessive proinflammatory response is thought to be important in the pathogenesis of septic shock. […] In scorpion envenomation the balance between pro- and anti-inflammatory cytokines determines the degree and extent of inflammation, and thus can lead to different clinical effects.

• #49 Scorpion Venom and the Inflammatory Response

  https://pmc.ncbi.nlm.nih.gov/articles/PMC2838227/

  The pathophysiology of envenomation is complex, but there is little doubt that injection often progresses from systemic inflammatory response to severe envenomation. […] The production and/or release of cytokines may also play a role in the development of hyperglycemia, in particular TNF- has been demonstrated to induce insulin resistance in animals models. […] The pathogenesis of tissue injury is complex and cannot be attributed to a single agent. Tissue injury occurs during inflammation and is a progressive process which may eventually lead to organ dysfunction and failure. […] The balance between pro- and anti-inflammatory activities determines the degree and extent of inflammation, and thus can lead to different clinical effects. […] An excessive proinflammatory response is thought to be important in the pathogenesis of septic shock. […] In scorpion envenomation the balance between pro- and anti-inflammatory cytokines determines the degree and extent of inflammation, and thus can lead to different clinical effects.

• #50 Indian Pediatrics – Editorial

  https://www.indianpediatrics.net/may2000/may-504-514.htm

  The unopposed effects of alpha receptors stimulation lead to suppression of insulin secretion, hyperglycemia, hyperkalemia, free fatty acids and free radicals accumulation injurious to myocardium. […] Changes in blood coagulation profile and presence of acute disseminated intravascular coagulation (DIC) were observed in dogs after scorpion venom injection. […] Direct effect of toxins on neurons could contribute to seizures and encephalopathy in some children. […] Systemic inflammatory response like syndrome is triggered during envenomation caused by scorpion species Tityus serrulatus. […] Increased levels of Interleukin-6, IL-1a and IFN- gamma were seen in all patients. […] The role of i NOS in causing direct tissue injury due to scorpion venom deserves further study. […] Clinical acceptance of prazosin for scorpion sting now exists. […] The usefulness of prazosin therapy in this condition was scientifically established in mid-eighties in India. […] Since the use of prazosin (1984 onwards) the mortality in these victims is reduced to less than 1%.

• #51 Indian Pediatrics – Editorial

  https://www.indianpediatrics.net/may2000/may-504-514.htm

  The unopposed effects of alpha receptors stimulation lead to suppression of insulin secretion, hyperglycemia, hyperkalemia, free fatty acids and free radicals accumulation injurious to myocardium. […] Changes in blood coagulation profile and presence of acute disseminated intravascular coagulation (DIC) were observed in dogs after scorpion venom injection. […] Direct effect of toxins on neurons could contribute to seizures and encephalopathy in some children. […] Systemic inflammatory response like syndrome is triggered during envenomation caused by scorpion species Tityus serrulatus. […] Increased levels of Interleukin-6, IL-1a and IFN- gamma were seen in all patients. […] The role of i NOS in causing direct tissue injury due to scorpion venom deserves further study. […] Clinical acceptance of prazosin for scorpion sting now exists. […] The usefulness of prazosin therapy in this condition was scientifically established in mid-eighties in India. […] Since the use of prazosin (1984 onwards) the mortality in these victims is reduced to less than 1%.

• #52 SCORPION STING .pptx

  https://www.slideshare.net/slideshow/scorpion-sting-pptx-259451188/259451188

  11) Scorpion venom can cause alteration in clotting pathway and disseminated intravascular coagulation. […] 12) Acute lung injury may occur from microthrombi. […] 13) Stroke may occur due to thrombosis, hemorrhage, or cerebral vasospasm. […] 14) Acute renal failure may occur due to severe hemolysis. […] 15) Liver necrosis and raised enzymes may occur due to scorpion sting. […] 16) Clinical picture may evolve within 30 minutes to 6 hours and subside within a day or two. […] 17) Severity is dependent on the potency of a particular species venom, volume of venom injected, and body weight of the victim. […] 18) The symptomatology can be broadly divided into local, systemic manifestations, and complications. […] 19) Systemic manifestations include features of cholinergic storm starting from 04 hours (can last for 6-13 hours) followed by features of adrenergic stimulation which starts at 4 hours and can last up to 48 hours.

• #53 Indian Pediatrics – Editorial

  https://www.indianpediatrics.net/may2000/may-504-514.htm

  The unopposed effects of alpha receptors stimulation lead to suppression of insulin secretion, hyperglycemia, hyperkalemia, free fatty acids and free radicals accumulation injurious to myocardium. […] Changes in blood coagulation profile and presence of acute disseminated intravascular coagulation (DIC) were observed in dogs after scorpion venom injection. […] Direct effect of toxins on neurons could contribute to seizures and encephalopathy in some children. […] Systemic inflammatory response like syndrome is triggered during envenomation caused by scorpion species Tityus serrulatus. […] Increased levels of Interleukin-6, IL-1a and IFN- gamma were seen in all patients. […] The role of i NOS in causing direct tissue injury due to scorpion venom deserves further study. […] Clinical acceptance of prazosin for scorpion sting now exists. […] The usefulness of prazosin therapy in this condition was scientifically established in mid-eighties in India. […] Since the use of prazosin (1984 onwards) the mortality in these victims is reduced to less than 1%.

• #54

  https://journals.lww.com/jneuro-ophthalmology/fulltext/2009/06000/cerebral_blindness_after_scorpion_sting.15.aspx

  A scorpion bite affects the central nervous system in three ways: altered consciousness, seizures, and infarctions. […] Cerebral and/or cerebellar infarctions have been reported, with numerous mechanisms advanced to explain them: 1) an acute rise in blood pressure during the autonomic storm that ruptures unprotected or diseased vessels; 2) toxic myocarditis that precipitates arrhythmias that give rise to embolic stroke; 3) hypercoagulability; 4) disseminated intravascular coagulation; 5) vasculitis caused by venom; and 6) hypotension caused by myocarditis, parasympathetic overactivity, and dehydration. […] We believe that this is the first description of persistent (and severe) cerebral visual loss after a scorpion bite. We cannot be certain of the mechanism, although hypotension seems likely.

• #55

  https://journals.lww.com/jneuro-ophthalmology/fulltext/2009/06000/cerebral_blindness_after_scorpion_sting.15.aspx

  A scorpion bite affects the central nervous system in three ways: altered consciousness, seizures, and infarctions. […] Cerebral and/or cerebellar infarctions have been reported, with numerous mechanisms advanced to explain them: 1) an acute rise in blood pressure during the autonomic storm that ruptures unprotected or diseased vessels; 2) toxic myocarditis that precipitates arrhythmias that give rise to embolic stroke; 3) hypercoagulability; 4) disseminated intravascular coagulation; 5) vasculitis caused by venom; and 6) hypotension caused by myocarditis, parasympathetic overactivity, and dehydration. […] We believe that this is the first description of persistent (and severe) cerebral visual loss after a scorpion bite. We cannot be certain of the mechanism, although hypotension seems likely.

• #56 SciELO Brazil – Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review

  https://www.scielo.br/j/rimtsp/a/rZvfqJgs37hLrCCmBsjGnhG/

  Acute pancreatitis is another unusual manifestation after scorpion sting and has been described in human victims stung by the genre Tityus and Leiurus. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. Firstly, the occurrence of intravascular hemolysis, which could not appear in urine if it is mild and could vary according to the scorpion species. […] The highest concentration of scorpion venom is in the kidneys, mainly because of the fast redistribution of the venom from the blood to the tissues coupled with the slow removal of venom from the kidney. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. […] The mainstay of pancreatitis pathogenesis due to scorpion sting is the cholinergic discharge induced by its toxins.

• #57 SciELO Brazil – Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review

  https://www.scielo.br/j/rimtsp/a/rZvfqJgs37hLrCCmBsjGnhG/

  Acute pancreatitis is another unusual manifestation after scorpion sting and has been described in human victims stung by the genre Tityus and Leiurus. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. Firstly, the occurrence of intravascular hemolysis, which could not appear in urine if it is mild and could vary according to the scorpion species. […] The highest concentration of scorpion venom is in the kidneys, mainly because of the fast redistribution of the venom from the blood to the tissues coupled with the slow removal of venom from the kidney. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. […] The mainstay of pancreatitis pathogenesis due to scorpion sting is the cholinergic discharge induced by its toxins.

• #58 SciELO Brazil – Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review

  https://www.scielo.br/j/rimtsp/a/rZvfqJgs37hLrCCmBsjGnhG/

  The toxin-mediated cholinergic discharge that takes place in the pancreas might promote premature activation of the enzymes produced within the acinar cell. These enzyme precursors, with inflammatory mediators, are released from the damaged pancreatic tissue and are capable of altering the function of the other organs, such as the lungs.

• #59 Scorpion Venom Provides Clues to Cause, Treatment of Pancreatitis | NC State News

  https://news.ncsu.edu/2010/03/weninger/

  A common result of scorpion stings, pancreatitis is an inflammation of the pancreas. […] Fletcher pinpointed a protein production system found in the pancreas that seemed to be targeted by the venom of the Brazilian scorpion Tityus serrulatus. […] We found that a particular enzyme in the scorpions venom removes a peptide, or small protein, that allows the vesicle to fuse with the cell membrane, Fletcher says. If you remove a pancreatic cells ability to absorb or release components, you end up with pancreatitis. […] The unique cleavages of VAMP2 and VAMP8 may be linked to pancreatitis that develops following scorpion envenomation as both of these v-SNARE proteins are associated with zymogen granule membranes in pancreatic acinar cells.

• #60 Scorpion Venom Provides Clues to Cause, Treatment of Pancreatitis | NC State News

  https://news.ncsu.edu/2010/03/weninger/

  A common result of scorpion stings, pancreatitis is an inflammation of the pancreas. […] Fletcher pinpointed a protein production system found in the pancreas that seemed to be targeted by the venom of the Brazilian scorpion Tityus serrulatus. […] We found that a particular enzyme in the scorpions venom removes a peptide, or small protein, that allows the vesicle to fuse with the cell membrane, Fletcher says. If you remove a pancreatic cells ability to absorb or release components, you end up with pancreatitis. […] The unique cleavages of VAMP2 and VAMP8 may be linked to pancreatitis that develops following scorpion envenomation as both of these v-SNARE proteins are associated with zymogen granule membranes in pancreatic acinar cells.

• #61 Scorpion Venom Provides Clues to Cause, Treatment of Pancreatitis | NC State News

  https://news.ncsu.edu/2010/03/weninger/

  A common result of scorpion stings, pancreatitis is an inflammation of the pancreas. […] Fletcher pinpointed a protein production system found in the pancreas that seemed to be targeted by the venom of the Brazilian scorpion Tityus serrulatus. […] We found that a particular enzyme in the scorpions venom removes a peptide, or small protein, that allows the vesicle to fuse with the cell membrane, Fletcher says. If you remove a pancreatic cells ability to absorb or release components, you end up with pancreatitis. […] The unique cleavages of VAMP2 and VAMP8 may be linked to pancreatitis that develops following scorpion envenomation as both of these v-SNARE proteins are associated with zymogen granule membranes in pancreatic acinar cells.

• #62 SciELO Brazil – Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review

  https://www.scielo.br/j/rimtsp/a/rZvfqJgs37hLrCCmBsjGnhG/

  Acute pancreatitis is another unusual manifestation after scorpion sting and has been described in human victims stung by the genre Tityus and Leiurus. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. Firstly, the occurrence of intravascular hemolysis, which could not appear in urine if it is mild and could vary according to the scorpion species. […] The highest concentration of scorpion venom is in the kidneys, mainly because of the fast redistribution of the venom from the blood to the tissues coupled with the slow removal of venom from the kidney. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. […] The mainstay of pancreatitis pathogenesis due to scorpion sting is the cholinergic discharge induced by its toxins.

• #63 SciELO Brazil – Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review

  https://www.scielo.br/j/rimtsp/a/rZvfqJgs37hLrCCmBsjGnhG/

  Acute pancreatitis is another unusual manifestation after scorpion sting and has been described in human victims stung by the genre Tityus and Leiurus. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. Firstly, the occurrence of intravascular hemolysis, which could not appear in urine if it is mild and could vary according to the scorpion species. […] The highest concentration of scorpion venom is in the kidneys, mainly because of the fast redistribution of the venom from the blood to the tissues coupled with the slow removal of venom from the kidney. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. […] The mainstay of pancreatitis pathogenesis due to scorpion sting is the cholinergic discharge induced by its toxins.

• #64 SciELO Brazil – Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review

  https://www.scielo.br/j/rimtsp/a/rZvfqJgs37hLrCCmBsjGnhG/

  Acute pancreatitis is another unusual manifestation after scorpion sting and has been described in human victims stung by the genre Tityus and Leiurus. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. Firstly, the occurrence of intravascular hemolysis, which could not appear in urine if it is mild and could vary according to the scorpion species. […] The highest concentration of scorpion venom is in the kidneys, mainly because of the fast redistribution of the venom from the blood to the tissues coupled with the slow removal of venom from the kidney. […] The pathogenesis of AKI following a scorpion sting involves diverse mechanisms. […] The mainstay of pancreatitis pathogenesis due to scorpion sting is the cholinergic discharge induced by its toxins.

• #65 SciELO Brazil – Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review Acute kidney injury and pancreatitis due to scorpion sting: case report and literature review

  https://www.scielo.br/j/rimtsp/a/rZvfqJgs37hLrCCmBsjGnhG/

  Scorpion envenomation is reported in many parts of the world and is more frequent in tropical and subtropical countries. It is an important public health problem in Brazil due to its high frequency and potential to cause severe clinical manifestations, which could even be fatal. The clinical presentation of envenomation is relatively similar, regardless of the species, and includes neurotoxic syndromes mediated by sympathetic and parasympathetic systems. […] The diagnosis of scorpion sting is based on epidemiological features, clinical signs, symptoms, and exclusion of other etiologies. […] The direct effect of scorpion venom on the kidneys and damage resulting from intravascular hemolysis disseminated intravascular coagulation (DIC), hemolytic uremic syndrome and hypovolemia have been investigated in clinical and experimental studies. The early detection of the occurrence of acute kidney injury (AKI) is essential in these patients because the consequences can be very severe if not correctly managed.

• #66 B187 Successful outcome of spinal anaesthesia in a patient with a history of scorpion sting and failed spinal anaesthesia | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/47/Suppl_1/A174.2

  Scorpion stings can cause failure of spinal anaesthesia. […] The scorpion toxins cause repetitive action potentials and persistent depolarization of sodium channels in nerve axons. An antigen-antibody response also may cause competitive antagonism of sodium channels. […] We are not clear whether there is remodelling of the receptor resulting in resistance to local anaesthetics. Our presumption was that adjuvants can enhance the action of local anaesthetics and reverse this mechanism.

• #67 B187 Successful outcome of spinal anaesthesia in a patient with a history of scorpion sting and failed spinal anaesthesia | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/47/Suppl_1/A174.2

  Scorpion stings can cause failure of spinal anaesthesia. […] The scorpion toxins cause repetitive action potentials and persistent depolarization of sodium channels in nerve axons. An antigen-antibody response also may cause competitive antagonism of sodium channels. […] We are not clear whether there is remodelling of the receptor resulting in resistance to local anaesthetics. Our presumption was that adjuvants can enhance the action of local anaesthetics and reverse this mechanism.

• #68 B187 Successful outcome of spinal anaesthesia in a patient with a history of scorpion sting and failed spinal anaesthesia | Regional Anesthesia & Pain Medicine

  https://rapm.bmj.com/content/47/Suppl_1/A174.2

  Scorpion stings can cause failure of spinal anaesthesia. […] The scorpion toxins cause repetitive action potentials and persistent depolarization of sodium channels in nerve axons. An antigen-antibody response also may cause competitive antagonism of sodium channels. […] We are not clear whether there is remodelling of the receptor resulting in resistance to local anaesthetics. Our presumption was that adjuvants can enhance the action of local anaesthetics and reverse this mechanism.

• #69

  https://jad.tums.ac.ir/index.php/jad/article/view/1549

  Clinical manifestations of Scorpion sting toxicity vary due to the existence of two toxic classes of neurotoxins and cytotoxins or hemotoxins in these arthropods in Iran. […] Treatment and prevention of scorpion stings in Iran and neighboring countries in the Middle East should be planned based on the mechanism of toxicity and the presence of toxic classes with neurotoxic or cytotoxic venoms.

• #70

  https://publish.kne-publishing.com/index.php/JAD/article/view/13616

  Considering the importance of scorpions and recognizing the mechanisms of toxicity caused by their medically important species in Iran and adopting the best therapeutic approach based on these mechanisms, this study was performed by reviewing the clinical manifestations of scorpion stings. […] Clinical manifestations of Scorpion sting toxicity vary due to the existence of two toxic classes of neurotoxins and cytotoxins or hemotoxins in these arthropods in Iran. […] Treatment and prevention of scorpion stings in Iran and neighboring countries in the Middle East should be planned based on the mechanism of toxicity and the presence of toxic classes with neurotoxic or cytotoxic venoms.

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