A retrospective analysis of a rural set up experience with special reference to dobutamine in prazosin-resistant scorpion sting cases.

INTRODUCTION Incidence of scorpion sting is high in west coast of Maharashtra. Scorpion sting gives rise to cardiotoxicity and it is our observation that in spite of using prazosin in initial phases, patients still developed severe cardiotoxicity and dobutamine was effective in reducing the mortality in these patients. So we want to convey this message to many of our doctor friends who practice in rural area. OBJECTIVES Death due to scorpion sting is common in rural parts of India. Prazosin is supposed to be a physiological & pharmalogical antidote of the scorpion venom but we studied efficacy of dobutamine in prazosin-resistant cardiotoxic cases. METHODS This study was a retrospective analysis of 242 patients admitted from January 1999 to December 2006. We classified these patients clinically in three groups Mild, Moderate and Severe Envenomation. For treatment plan 4 groups were made; where patients received Dobutamine + Prazosin / No Do + PR / No Pr + No Do / Do + No PR. Effect of these two drugs was compared on the basis of mortality ratio in all 4 groups. RESULTS Out of 242 patients 141 patients developed cardiotoxicity. Out of them 96 had received prazosin as a first line of treatment. Out of 96, 23 needed dobutamine to treat cardiac complications. Mortality was highest in only prazosin, no dobutamine group and lowest in prazosin, dobutamine group. CONCLUSION In initial phases of autonomic storm i.e. accelerated hypertension one can use prazosin but monitor the patient for left ventricular failure and clinically if patient develops LVF add dobutamine to prevent death. Addition of Dobutamine can be life-saving.