{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T18:00:24Z","timestamp":1778954424171,"version":"3.51.4"},"reference-count":27,"publisher":"BMJ","issue":"5","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Heart"],"accepted":{"date-parts":[[1997,1,22]]},"published-print":{"date-parts":[[1998,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>Objective<\/jats:title>\n                  <jats:p>To study cardiovascular haemodynamics following scorpion envenomation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Setting<\/jats:title>\n                  <jats:p>Intensive care unit of a university hospital.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Patients<\/jats:title>\n                  <jats:p>Eight patients with Indian red scorpion (<jats:italic>Mesobuthus tamulus<\/jats:italic>) stings.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Intervention<\/jats:title>\n                  <jats:p>Captopril (6.25 to 12.5\u2009mg orally) every 30 minutes until pulmonary oedema resolved.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Main outcome measures<\/jats:title>\n                  <jats:p>Haemodynamic data obtained by pulmonary artery catheterisation.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Two haemodynamic patterns were seen. There was a predominant vascular effect in one patient, with severe hypertension, tachycardia, increased systemic vascular resistance index (SVRI\u2009=\u20095893\u2009dyn.s.cm<jats:sup>-5<\/jats:sup>), and normal cardiac index (2.73\u2009l\/m<jats:sup>2<\/jats:sup>). A predominant myocardial effect with left ventricular dysfunction and normal right ventricular function was seen in the other seven patients, with tachycardia, pulmonary oedema, mild hypotension, reduced stroke volume (mean (SD), 25.9 (8.3)\u2009ml\/m<jats:sup>2<\/jats:sup>), normal SVRI (1812 (831)\u2009dyn.s.cm<jats:sup>\u22125<\/jats:sup>), and increased pulmonary artery wedge pressure (PAWP\u2009=\u200925 (4.4)\u2009mm\u2009Hg). Following mild dehydration pulmonary oedema subsided (PAWP\u2009=\u200914 (8.5)\u2009mm\u2009Hg) in three of these patients, but hypovolaemic shock developed (right atrial pressure (RAP)\u2009=\u20091.3 (2.1)\u2009mm\u2009Hg); pulmonary oedema recurred with rehydration. One patient developed fatal cardiogenic shock with raised PAWP (27\u2009mm\u2009Hg) and RAP (11\u2009mm\u2009Hg), and vasodilatation (SVRI\u2009=\u20091129\u2009dyn.s.cm<jats:sup>\u22125<\/jats:sup>). Stroke volume (30.5 (8.7)\u2009ml\/m<jats:sup>2<\/jats:sup>) and cardiac output (4.3 (1.5)\u2009l\/m<jats:sup>2<\/jats:sup>) improved with resolution of pulmonary oedema (PAWP\u2009=\u200914.4 (4.2)\u2009mm\u2009Hg) following afterload reduction with captopril.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Mild envenomation causes severe vasoconstriction and hypertension. Severe envenomation produces predominant left ventricular dysfunction with normal systemic vascular resistance manifesting as pulmonary oedema or severe hypotension depending on the fluid balance. Shock due to biventricular dysfunction and vasodilatation occurs terminally.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/hrt.79.5.485","type":"journal-article","created":{"date-parts":[[2014,10,22]],"date-time":"2014-10-22T15:31:45Z","timestamp":1413991905000},"page":"485-489","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":47,"title":["Haemodynamic patterns in patients with scorpion envenomation"],"prefix":"10.1136","volume":"79","author":[{"given":"D R","family":"Karnad","sequence":"first","affiliation":[{"name":"Medical-Neurology-Neurosurgery Intensive Care Unit, Department of Medicine, King Edward VII Memorial Hospital, Parel, Bombay 400 012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1998,5,1]]},"reference":[{"key":"2025101723094351000_79.5.485.1","doi-asserted-by":"publisher","DOI":"10.1177\/004947559702700105"},{"key":"2025101723094351000_79.5.485.2","doi-asserted-by":"publisher","DOI":"10.1016\/0035-9203(89)90354-4"},{"key":"2025101723094351000_79.5.485.3","first-page":"355","article-title":"Fractionation and biological activities of venoms of the Indian scorpions Buthus tamulus and Heterometrus bengalensis.","volume":"23","author":"Ramachandran","year":"1986","journal-title":"Ind J Biochem Biophys"},{"key":"2025101723094351000_79.5.485.4","unstructured":"Russell FE (1986) Toxic effects of animal toxins. in Toxicology\u2014the basic science of poisons, eds Idaassen CD Amdur MO Doull J (Macmillan, New York), 3rd ed. pp 706\u2013756."},{"key":"2025101723094351000_79.5.485.5","doi-asserted-by":"publisher","DOI":"10.1007\/BF01711538"},{"key":"2025101723094351000_79.5.485.6","doi-asserted-by":"publisher","DOI":"10.1016\/0006-8993(73)90065-6"},{"key":"2025101723094351000_79.5.485.7","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1016\/0041-0101(68)90086-X","article-title":"Effect of the venom of the scorpion Tityus serrulatus on adrenal gland catecholamines.","volume":"5","author":"Henriques","year":"1968","journal-title":"Toxicon"},{"key":"2025101723094351000_79.5.485.8","first-page":"376","article-title":"Elevated plasma angiotensin levels in dogs by Indian red scorpion (Buthus tamulus) venom and its reversal by administration of insulin and tolazoline.","volume":"88","author":"Murthy","year":"1988","journal-title":"Ind J Med Res"},{"key":"2025101723094351000_79.5.485.9","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1016\/0041-0101(94)90327-1","article-title":"Abnormal coronary perfusion in experimental scorpion envenomation.","volume":"32","author":"Margulis","year":"1994","journal-title":"Toxicon"},{"key":"2025101723094351000_79.5.485.10","first-page":"369","article-title":"Increase in serum free fatty acids, phospholipids and reduction in total cholesterol in acute myocarditis produced by scorpion (Buthus tamulus) venom injection in dogs.","volume":"38","author":"Murthy","year":"1986","journal-title":"Ind Heart J"},{"key":"2025101723094351000_79.5.485.11","doi-asserted-by":"publisher","DOI":"10.1016\/0041-0101(94)90108-2"},{"key":"2025101723094351000_79.5.485.12","doi-asserted-by":"crossref","first-page":"855","DOI":"10.1016\/0041-0101(82)90073-3","article-title":"Effects of purified scorpion toxin (Tityus toxin) on the isolated guinea pig heart.","volume":"20","author":"Almeida","year":"1982","journal-title":"Toxicon"},{"key":"2025101723094351000_79.5.485.13","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1016\/0041-0101(90)90329-6","article-title":"Vasodilators and calcium channel blocking agents as treatment of cardiovascular manifestations of human scorpion envenomation.","volume":"28","author":"Gueron","year":"1990","journal-title":"Toxicon"},{"key":"2025101723094351000_79.5.485.14","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1080\/00034983.1987.11812175","article-title":"Prazosin for vasodilator treatment of acute pulmonary oedema due to scorpion sting.","volume":"87","author":"Bawaskar","year":"1987","journal-title":"Ann Trop Med Parasitol"},{"key":"2025101723094351000_79.5.485.15","doi-asserted-by":"crossref","first-page":"1430","DOI":"10.1136\/bmj.298.6685.1430","article-title":"Captopril for correcting diuretic-induced hypotension in pulmonary oedema after scorpion sting.","volume":"298","author":"Karnad","year":"1989","journal-title":"BMJ"},{"key":"2025101723094351000_79.5.485.16","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1016\/0041-0101(92)90507-2","article-title":"Issues in management of scorpion sting in children.","volume":"30","author":"El-Amin","year":"1992","journal-title":"Toxicon"},{"key":"2025101723094351000_79.5.485.17","doi-asserted-by":"crossref","unstructured":"Campos JA, Silva OA, Lopez M, et al. 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