toxicliniqThe official newsletter of Toxicology & National Poisons Information Centre, National Hospital of Sri Lanka

Volume - 01June 2013

Introduction :

A scorpion species proved to be lethal

to humans was recently recorded

from Jaffna Peninsula, mainly in

Palaly, Achchuveli and Karainagar.

These species morphologically differ

from all other known scorpions in Sri

Lanka, and was identified as Hot-

tentotta Humulus (scorpions buthidae

family), which is commonly found

in Maharashtra India. Red scorpion

which inhabits neighbouring India

has not seen in Sri Lanka till 2000.

Red scorpion which may have had an

accidental entry to the North of Sri

Lanka with the IPKF- Indian Peace

Keeping Force (is landed to Sri Lanka

on July -31 ,1987 more than 25 years

ago) have gradually multiplied to be-

come a menace to the General public

of the Jaffna area.

The need of the hour now is to

word off the higher risk of the Red

scorpion infiltrating other parts of

the Country with goods and sand

being brought from those areas.

Invasion of IndianScorpion

Toxicology Newsletter is an up-

dated information collection for the

healthcare practitioner that intended

to enhance knowledge, stimulate

research and promote better man-

agement of patients with poisoning.

The newsletter also publishes clini-

cally relevent review articles, letters

to the editor and commentaries.

Themes covers are of interest to cli-

nicians, researchers, epidemiologists

and other health care professionals.

toxicliniq-01.indd 1 7/16/13 7:10 AM

toxicliniq - june 20132

Identification : Size : 5 10 cm

Colour : Dark orange to dull

brown with darker grey ridges

and granulations on the body

and grey spots over the thorax.

These ridges bear three dis-

tinct plaques on the back of

the body. Legs and its tips are

brighter red in colour.

Habitat : Nocturnal bites com-

mon at night or early morning.

Found in tropical humid cli-

mates / dark places in house-

hold / grassy stony hill slopes,

sandy beaches.

In household, on clothes,

under cupboards, furniture,

mounds of leaves, stacks of

firewood or logs.

Toxin - Tamapin / Iberio-toxin blocks the calcium

dependant K channels. Sever-

ity of scorpion sting depends

on the dose of venom, size of

scorpion, season, age of victim

and time between sting and

hospital admission.

The scorpion stinger by which

venom is injected is short and

sharp, 3-4 mm long enabling

it to deposit the venom, deep

in the skin, skin circulation is

sluggish and normally remains

quiescent.

Soon after stinging the rapidly

absorbed venom evoked au-

tonomic storm, owning sud-

den pouring of endogenous

catecholamines into the cir-

culation. Alpha receptors are

stimulated by circulating cat-

echolamines causing cold skin

due to vasoconstriction which

further arrests absorption of

venom from sting site.

Mechanism of Action : Ven-oms delay the closing of Na

Channels in nurones resulting

increased endogenous catechol-

amines into blood. Toxin also

caused prolonged sympathetic

and transient parasympathetic

stimulation.

Morbidity and mortality is due

to acute refractory pulmonary

oedema, cardiogenic shock, and

multiorgan failure.

Cockroaches can contaminate food with their waste and saliva

which contains bacteria that can

cause food poisoning, diarrhea,

and Stephylococcus infections.

We know that breathing dust con-

taining cockroach feces or body

parts can cause an allergic reac-

tion and asthma, especially in

children. As far as the diseases

that cockroaches can spread, they

can pick up Salmonella on their

legs and deposit it to food, which

can cause food poisoning if in-

gested.

Sanitation is the first phase in a

cockroach control program and

Cockroaches can make you sick!

you should make efforts to re-

duce water, food and shelter

available to cockroaches.

Here are a few quick tips:

1. Place all food or edible ma-

terial in tightly sealed con-

tainers. This includes pet

food.

2. Remove trash on a regular

basis.

3. Clean up all areas where

spilled food and crumbs may

accumulate. This includes

under stoves, refrigerators,

and behind cupboards. Of

course, make sure cooking

and eating surfaces are clean.

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toxicliniq - june 2013 3

CHIEF EDITOR: Dr. Waruna Gunathilaka - Consultant Physician, Head - Toxicol-ogy & National Poisons Information Centre CO-EDITORS: Dr. P.A.B. Karunanayake, Dr. Nihal Peeris EDITORIAL ASSISTANTS: Ms. H.D.H.D. Shiromini Nissanka - Research Officer, Mrs. A.D. Weerasuriya - Research Officer, Mrs. Rukma Warnalatha - Public Management Assistant, Miss.K.M.S.M.Disanayaka - Graduate Trainee

Clinical ManagementFirst aid & Treatment

Needs urgent medical attention

It is a Medical emergency.

Reassure and calm down the

patient.

Keep left lateral position, if un-

conscious to prevent aspiration.

Immobilize the bitten part leg

/ hand

Clean the affected site with an

Prazosin is an Alpha receptor

blocker, and by blocking Alpha

receptors, prazosin decrease pre-

load and left ventricular impen-

dence without increasing heart

rate.

It is a pharmacological and physi-

ological antidote to venom actions,

that freely available.

antiseptic and disinfect.

Analgesics for pain. Ex:

Paracetamol

If in shock / dehydrated - ORS

/ Iv fluids (Normal saline /

Hartmans solution)

If blood pressure low dopamine

infusion

Propped up position with O2 if

needed

If respiratory difficulty with

rhonchi / crepts: nebulization

with Salbutamol / Aminophyl-

lin infusion as bronchodilators

and control BP if high

Presence of clinical signs and

symptoms of excess acetylcholine

indicate the presence of active free

circulating venom in blood which

can be reversed with prazosin.

Morbidity and Mortality due to

envenoming are caused by sympa-

thetic over stimulation and not by

parasympathetic stimulation.

Do not keep shoes, boots,

clothes or wet towels out-

doors where scorpions can

hide.

Shake towels and all clothing

and shoes before putting them

on.

Use gloves when working in

the yard/farms.

Wear shoes outdoors, mainly

during evenings / nights,

carrying a torch when going

outdoors.

Scorpions glow brightly under

black light and are easily

found and removed.

Scorpions can enter buildings

/ houses through openings

around plumbing fixtures and

Loose- fitting doors and win-

dows and cracks in foundation

walls.

Yellow outdoor lighting is less

attractive to insects and rec-

ommended in areas surround-

ing a house, because scorpions

are difficult to control with

insecticides.

Place of Prazosin in Treatment of Scorpion Bite

Prevention of Scorpion Bites

toxicliniq

Grade: 1

severe, excruciating local pain

at the sting site radiating along

with corresponding dermatomes,

mild local oedema with sweating

at the sting site, without systemic

involvement

Grade: 2

signs and symptoms of autonomic

storm characterised by acetylcho-

line excess or parasympathetic

stimulation (vomiting, profuse

sweating from all over body, ropy

salivation, bradycardia, prema-

ture ventricular contraction,

hypotension, priapism in men)

and sympathetic stimulation

(hypotension with blood pressure

140/90,tachycardia with heart

rate 120 per minute, cold extrem-

ities, transient systolic murmur).

Grade: 3

cold extremities, tachycardia,

hypotension or hypertension with

pulmonary oedema (respiratory

rate 24 per minute, basal rales or

crackles in lungs.)

Grade: 4

tachycardia, hypotension with or

without pulmonary oedema with

warm extremities (warm shock)

Evaluation of clinical grade of scorpion sting on arrival at hospital

48%

Scorpion bite Statistics in Jaffna:

January 2012 February 2013

(80 cases)

of which 52% Females

48% Males

of 30% of children - 3 to 12 years

48%

toxicliniq-01.indd 3 7/16/13 7:10 AM

Toxicliniq,Toxicology & National Poisons Information Centre,National Hospital, Colombo, Sri Lanka.

Tel : 011-2686143, 011-2691111-Ext. 2430 E-mail: nctnhsl@health.gov.lk

National Toxicology & Poisons Information Center

poisoned? 0112-686-143(

Saturdays 8:00 AM - 12:00 PM

weekly 8:00 AM - 4:00 PM

If undelivered return to:

toxicliniqjune 2013

Protective Measures at Home

Clean the garden by removing

all trash, logs, boards, stones,

bricks and other objects around

the home.

Cut overhanging tree branches

away from house because they

can provide a path to the roof

for scorpions.

Do not store firewood inside

house, bring only in small

quantities and check before

taking inside house.

Fix weather stripping around

loose-fitting doors and windows.

Seal around roof caves, pipes

and other cracks that allow

entrance into the home.

Make sure window screens fit

tightly in the window frame.

References1. BMJ - Research Efficacy

and safety of Scorpion antivenom

plus prazosin compared with pra-

zosin alone for venomous Scorpion

(Mesobuthus) sting: randomized

open label clinical trial. 2010-

34107136 on line doi 101136

BMJ C.7136, Page 1-8

2. Euscorpius Occasional

Publications in Scorpiology - First

report on Hottentota tumulus

From Sri Lanka and its medical

importance - 4 th March 2013- NO-

155, page 1-2

3. UC- IPM online Scorpions

Management guidelines Revised.

12/11,2013-04-02, page 3-4

We welcome your comments

and suggestions regarding the

newsletter

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