Correlation of CPK-MB and LVEF with Pulmonary Edema in Cases with Scorpion Sting

  • Adarsh Purohit Associate Professor, Department of Paediatrics, Ananta Institute of Medical Sciences(AIMS) and Research Centre, Rajsamand-Rajasthan
  • Sandeep Choudhary Associate Professor, Department of Paediatrics, Dr SN Medical College, Jodhpur-Rajasthan.
Keywords: Scorpion Sting, LVEF, Pulmonary Edema

Abstract

Background: To study correlation between rise in CPK-MB and Fall in Left Ventricular Ejection Fraction (LVEF) with Pulmonary Edema in cases with Scorpion Sting.

Methods: Design: Randomised Controlled Trial, Subjects: 126 patients with scorpion sting. All the patients enrolled in the study were monitored clinically in ICU and investigated for markers of myocardial injury by S.CPK-MB and 2D Echocardiography for LVEF at admission. Results: in our study patients with left ventricular ejection fraction less than 40% had higher than normal value of serum CPK-MB (120.28 ± 88.76 IU/L), but the value of this cardiac enzyme was comparatively higher (155.1 ± 65.94) in those with normal left ventricular output. The cases with ejection fraction between 40-60% demonstrated the lowest values of CPK-MB (94.25 ± 94.25). It was observed that mean serum CPK-MB level was higher (130.4 ± 104.6 IU/L) in cases with pulmonary edema than in those without edema (113.3 ± 68.1 IU/L); however, this difference was statistically insignificant (p>0.20). Our second indicator of myocardial injury left ventricular ejection fraction was significantly lower (33 ± 14%) in cases with pulmonary edema when compared to those without edema (54 ± 11%), p-value being <0.01.

Conclusions: There is no direct relationship in CPK-MB level and fall in LVEF, meaning thereby there are other physiological factors affecting LVEF rather than only direct myocardial injury. Pulmonary Edema is mainly due to fall in LVEF. LVEF is a better indicator of the severity of myocardial injury than CPK-MB and can help in guiding the treatment.

 

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Author Biography

Sandeep Choudhary, Associate Professor, Department of Paediatrics, Dr SN Medical College, Jodhpur-Rajasthan.

 

 

References

1. Mahadevan S, Choudhury P, Puri RK, Srinivasan S. Scorpion envenomation and the role of lytic cocktail in its management. Indian J Pediatr 1981; 48: 757-761.
2. Gueron M, Yaron R. Cardiovascular manifestations of severe scorpion sting-clinicopathologic correlations. Chest 1970; 57(2): 156-62.
3. Bawaskar HS, Bawaskar PH. Scorpion sting: a review of 121 cases. J Wilderness Medicine 1991; 2: 164-174.
4. Bawaskar HS, Bawaskar PH. Severe envenoming by Indian red scorpion M. tamulus–the use of Prazosin therapy. Quart J Med 1996; 89: 701-704.
5. Mahadevan S. Scorpion sting. Indian Pediatr 2000; 37: 504-513.
6. Biswal Niranjan, Bashir Rani A, Murmu Uday C, Mathai Betsy, Balachander J, Srinivasan S. Indian J Pediatr 2006; 73: 577-582.
7. Elatrous S, Nouria S, Besbes-Ouanes L, Boussarsar M, Boukef R, Marghil S. Dobutamine in severe scorpion envenomation. Chest 1999; 116: 748-753.
8. Mounir Bouaziz, Mabrouk Bahloul, Leila Hergafi, Hatem Kallel, Leila Chaari, Chokri Ben Hamida, Adel Chaari, Hedi Chelly, Noureddine Rekik. Factors Associated with Pulmonary Edema in Severe Scorpion Sting Patients - A Multivariate Analysis of 428 Cases. Clinical Toxicology 2006; 44: 293 – 300.
9. Radha Krishna Murthy K, Abbas Zare M, Lida Haghnazari. The use of serotherapy to reverse ECG and cardiac enzyme changes caused by scorpion Mesobuthus tamulus concanesis, Pocock envenoming. J Venom Anim Toxins1999; 5: 154-71.
10. Abdel-Raheim A, Meki M, Zeinab M. Mohey El-Deen, Hassan M. Mohey El-Deen. Myocardial Injury in Scorpion Envenomed Children: Significance of Assessment of Serum Troponin I and Interleukin-8. NEL 2002; 23: 133-140.
11. Patil N Suvarna, Dhavalikar Sandeep, Khedekar Anita. Role of 2D Echocardiography in scorpion sting. www.swamisamarth.com
12. Abrough F, Ayari M, Nouira S. Assessment of left ventricular function in severe scorpion envenomation–combined hemodynamic and ECHO-doppler study. Inten Care Med 1995; 21: 629-635.
13. Karnad DR. Hemodynamic pattern in patients with scorpion envenomation. Heart 1998; 79: 485-489.
14. Maheshwari M, Tanwar CP. Scorpion Bite Induced Myocardial Damage and Pulmonary Edema.Heart Views 2012; 13(1): 16–18.
15. Agrawal A, Kumar A, Consul S, Yadav A. Scorpion bite, a sting to the heart!. Indian J Crit Care Med 2015;19(4):233-236.
16. Sagarad SV, Kerure SB, Thakur B, et al. Echocardiography guided therapy for myocarditis after scorpion sting envenomation. Journal of Clinical and Diagnostic Research : JCDR. 2013 Dec;7(12):2836-2838.
Published
2020-09-30
How to Cite
1.
Purohit A, Choudhary S. Correlation of CPK-MB and LVEF with Pulmonary Edema in Cases with Scorpion Sting. Int Arch BioMed Clin Res [Internet]. 2020Sep.30 [cited 2020Oct.21];6(3):PD9-PD11. Available from: http://iabcr.org/index.php/iabcr/article/view/621
Section
ORIGINAL ARTICLES ~ Paediatrics