Envenomation stings
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Transcript of Envenomation stings
ENVENOMATION:STINGS
M.S.V.Sudeep
Pharm.D. [4th yr].
ENVENOMATIONDefinition:
The injection of a venom etc by means of a sting,etc.
STINGS:
Def : A pointed portion of a insect used for attack.
Order of insects belongs to stings are:
a)Hymenoptera- bees, wasps, hornets, fire ants.
b)Scorpionida- scorpions.
Vespids ↓
Apids ↓
Formicids ↓
Wasps Honey Bees Fire ants
Hornets,Yellow jackets. -
Jumper ants
1) ORDER HYMENOPTERA:Temperate regions.
It consists of - Are as follows:
Body of Honey bee - bright yellow with black triangular marking on abdomen.
They attract to Sweet & Meat.(10-15mm length of body).
Queen wasps- grow up to 20mm.
Inject venom- barbed- by bees -50mcg venom injected.
-smooth- by wasps.
Ants- Use jaws & then sting/spray- local irritating venom.
Some contain abdomen stingers-multiple stings.
VENOM:
It contains - a) Biogenic amines - Histamins,ACH.
- b) Enzymes - Phospholipase A, Hyalouronidase.
- c) Toxic peptides - Kinins,Mast cell degranulation- peptides,Apamin,etc.
High risk factors Lab diagnosis
Age 60yrs/ more. Intradermal test
Prolonged attack time. Positive venom skin test
High no. of stings Radio allegro absorbent test
Medical history include c.vascular problems.
CLINICAL FEATURES:
Clinical features TreatmentLocal reaction: Single sting-not allergic to
venom-mild effects,local pain.Local reaction:at vital location:mouth-aedama,airway obstruction.By wasps-severe cutaneous infection& cellulitis.
1. Remove stings use fingernails/blade but avoid foreceps.
2. Adrenaline(1:1000)near sting site.3. Papain-Relief psin.
4. Local application – 20%Aluminium sulfate.
5. Antihistamins-Diphenydramine(500mg).
6. Chlorphenaramine(4mg)7. LOCAL ANTISEPTIC CREAM8. Antibiotics for oinfections.
Allergic rxn – a)Anaphylaxis:
4% human population- hypesensitive to venom.Signs- tingling sensation,flushing,vomiting.
0.1% adrenaline Antihistamins Corticosteroids Cardiac monitoring.
b) Delayed rxn:
Urticarial,skin rash,pedal edema.Sometimes fever,rash,malasia.
1. Antihistamins,2. Analgesics,3. Haemodialysis- for renal failure.
Toxic rxn: Multiple stings -
vasodilation,
hypotension,fatigue,
dirrhoea,headache,
seizeures.
Delayed toxic rxn:
Haemodialysis,coagulopathy.
Parenteral antihistamins.
Large dose corticosteroids.
Bronchodilators.Haemodialysis.
PREVENTIVE MEASURES: Individual recovered from anaphylaxis from insect trained to self administer
adrenaline.
Wear tag for unconscious persons - after sting bite to discover them.
Destroy Hymnoptera nests I areas near to you.
Wear light coloured ,long sleeved,tight clothes.
Avoid bright /attractive colours,floral patterns.
Attractive scents,perfumes,soaps,shampoo- avoid in high risk area.
Take βblockers/Non steroidal analgesics.
Avoid ACE inhibiotors/calcium channel Antagonist. Immune therpy for - benefit from allergy.
2) ORDER SCORPIONIDA: It consists of 8legs cephalothorax,6 segmented tail,telson,sting,2 claws to
catch prey.
650 different species- into 6 families.
Most species- nocturnal& seek area that rae cool& moist. Straw yellow/ light browm/black colour.
India – red scorpion(Mesobuthus tamulus)-03 inches in length. Larger scorpions(Palamnaeus species)
7inches in length.
General rule- scorpions with thick & powerful claws- less toxic. Slender claws- more toxic. Scorpion sting- they do not bite.
Venom :
1. Most potent.
2. It contain phospholipase,Ach,Hyaluronidase,serotonin,Neurotoxins.
3. It causes - Gastro intestinal & Pulmonary haemorrhages.
Mode of Action:
Venom affects Na+ channels with pprolongation of Action Potentials.
Depolarisation of Nerves of both Adenergic & Parasympathetic system.
LOCAL SYSTEMIC
Rapidly developing local pain Autonomic stimulation
swelling mydriasis
redness Profuse sweating
lymphadenopathy urticaria
HTN
convulsions
Priapism,nausea.
CLINICAL FEATURES:
Lab tests:
1. ECG – Elevated T waves. Elevated ST segment.
Treatment:
Child over age of 5years – local application of ice for pain relief.
TREATMENT:1)During transport to hospital:
Immobilize, No transport, Local ice apply, -ve pressure suction device. No incision/suction.
2)On Arrival at Hospital: 1. Rep. failure- Mech. Ventilation.2. Pain- PCM/Morphine tabs.3. Allergy- Antihistamins.4. HTN- Nifidepine.5. Correct fluid & acid base imbalance.6. Hypotension- Dopamine(2-5mcg/kg/min)7. Convulsions- Diaxepam(5-10mg)8. Vomiting- metoclopramide.9. Antivenom therapy- scorpion antivenom- 1vial in 10 ml injection.
References:1. Modern Medical Toxicology –vv. Pillay ,4th Edition.Pg:157.
2. Hodgson, Ernest (2010). A Textbook of Modern Toxicology. John Wiley and Sons.
3. Berg, N; De Wever, B; Fuchs, H. W.; Gaca, M; Krul, C; Roggen, E. L. (2011).
4. "Toxicology in the 21st century--working our way towards a visionary reality". Toxicology in Vitro 25 (4): 874–81