- Title
- Scorpion envenomation: reply
- Creator
- Isbister, Geoffrey K.; Bawaskar, Himmatrao S,; Brown, Simon G. A.
- Relation
- New England Journal of Medicine Vol. 371, Issue 16, p. 1557-1560
- Publisher Link
- http://dx.doi.org/10.1056/NEJMc1410354
- Publisher
- Massachusetts Medical Society
- Resource Type
- journal article
- Date
- 2014
- Description
- To the Editor: Life-threatening but reversible cardiomyopathy represents the major cause of death from old-world scorpions. In their review article, Isbister and Bawaskar (July 31 issue)1 conclude that antivenom holds a pivotal place in treating severe envenomation. We believe that, at least in resource-limited North African countries, antivenom should not be considered as first-line treatment. Highly species-specific antivenom is needed but is lacking for Androctonus mauritanicus and A. australis, the most lethal species in Morocco and Tunisia, respectively; poorly refined antivenom may induce severe side effects. Scorpion venoms contain low-molecular-weight peptides that rapidly distribute and induce a catecholaminergic storm, accounting for the clinical consequences.2 The time from the sting to the hospital admission limits the usefulness of the antivenom action to prevent mediator release and reduce lethality. Although supportive treatments alone efficiently improve cardiac function,3 no additional improvement with antivenom in envenomation from old-world scorpions was shown.4 Finally, the cost-effectiveness of antivenom remains limited.5 Thus, since authorities have to rationalize expenses, efforts to decrease scorpion-related lethality should be focused on standardizing supportive care, training professionals, launching information campaigns, and implementing care audits of hospitals (particularly in rural areas). Before the use of antivenom can be recommended, its efficacy should be established in randomized, controlled studies.
- Subject
- neurology/neurosurgery; public health; toxicology
- Identifier
- http://hdl.handle.net/1959.13/1299034
- Identifier
- uon:19774
- Identifier
- ISSN:0028-4793
- Language
- eng
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