Suppressed Insulin Secretion, Elevated Mediators of Inflammation, Hyper-Insulinemia-Insulin Resistance: Insulin Administration Reverses Cardiovascular, Metabolic Changes, Pulmonary Edema and All Other Clinical Manifestations in Scorpion Envenoming Syndrome

Abstract

Death due to poisonous scorpion stings is common in many tropical and sub-tropical countries. Scorpion envenoming syndrome causes stimulation of neuro-endocrine axis resulting in autonomic storm, intense stimulation of sympathetic nervous system, massive release of catecholamines, angiotensin II, suppressed insulin secretion, glucagon, glucocorticoids, increased free fatty acid levels, hyperglycemia, hyper-insulinemia, insulin resistance, acute myocarditis, initial hypertension, hypotension, arrhythmias, conduction defects, ischemia, infarction, acute pancreatitis, CNS damage, motor aphasia, hemiplegia, mydriasis, hyperhidrosis, acute respiratory distress syndrome, disseminated intravascular coagulation, multi system organ failure, shock and death. The scorpion envenoming syndrome also causes stimulation of immuno-pathological axis, systemic and local inflammation, increase in production of proinflammatory cytokines IL-1α, IL-1β, IL-4, IL-6, IL-10, IL-12, TNF-α, IFN-γ and NO and contribute to immunological imbalance, hyperglycemia, hyper-insulinemia, insulin resistance, multi-system organ failure, shock and death. Elevated levels of TNF-α cause impaired glucose tolerance and induce insulin resistance for endogenously secreted insulin. Insulin administration reversed metabolic, respiratory changes, cardiogenic and non-cardiogenic pulmonary edema, electrocardiographic, cardiovascular changes and many other manifestations in our experimental animals and in our scorpion sting victims with scorpion envenoming syndrome. Treatment: Continuous infusion of regular crystalline insulin at the rate of 0.3 U/g glucose and glucose at the rate of 0.1g/kg body weight/h, for 48–72 h, with supplementation of potassium as needed, maintenance of fluid, electrolytes, acidbase balance.