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<< Diagnosis And Management Of North American Snake And Scorpion Envenomations

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A provocative pilot study was conducted in children admitted to the hospital for a scorpion envenomation, using a before-after, quasi-experimental analysis of an intervention using prazosin, an alpha-receptor blocker. Unfortunately, this study was done in Tunisia, involving severe envenomations by North African scorpions and a control therapy using insulin and dextrose which is not standard in the US. Prazosin dosing was 30 micrograms/kg/dose orally at the time of presentation and repeated three hours after the first dose and every six hours thereafter as needed to alleviate signs of autonomic instability. Before beginning the prazosin intervention "standard therapy" was to use an insulin and dextrose mixture, intravenous fluids, and treatment of associated complications. Standard therapy was given in addition to prazosin. With 20 patients in the "before cohort" and 16 patients in the "after cohort," the authors reported that the prazosin group experienced fewer episodes of hypoglycemia and hyperkalemia; although, it is unclear if this is an effect of the scorpion venom or a side effect of the insulin/dextrose therapy. Only one of 16 patients in the prazosin group died, compared to seven of 20 in the control group. Hospital length-of-stay was reduced in the prazosin group from a mean of 71.5 hours to 46.3 hours.66 With the unavailability of scorpion antivenom in Arizona, there is a pressing need for a well designed, randomized, controlled trial of prazosin in the treatment of scorpion envenomations with systemic signs.

A randomized clinical trial of scorpion antivenom is currently being conducted. A two-year clinical trial of 50 patients, supported by a FDA grant to the University of Arizona, to study the effect of a new scorpion FAB fragment antivenom has been completed but was only reported in a Tuscon, Arizona newspaper. 67 The drug, Anascorp™, is made in Mexico and not yet approved for use by the FDA. The clinical trial overseen by researchers at the University of Arizona and the Arizona Poison Center in Tucson reported that the drug used in > 100 Arizona children demonstrated benefit.

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Last Modified: 06/27/2017
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