Scorpion envenoming is a frequent and deadly event in Tunisia. It is caused mainly by Androctonus australis and Buthus occitanus.
Pulmonary edema and
shock following
scorpion envenoming are related to
adrenergic cardiomyopathy, and are the main symptoms leading to death. Our aim was to search for the effect of
dobutamine on "scorpion
myocardiopathy" and to define the optimal dose of
dobutamine to start with. This study was conducted in the medical surgical ICU of Habib Bourguiba University Hospital in Sfax - Tunisia. We included 21 patients with
pulmonary edema or hemodynamic
shock following
scorpion envenoming. All patients were monitored using Swan-Ganz
catheter. After a first check of the hemodynamic parameters (baseline), all patients received
dobutamine infusion at 5, 10, and 15 μg/kg/min. The median age of patients was 19 years (IQR: 14-26) and 12 patients (57.1%) were males. On ICU admission, 11 patients (52.4%) had
shock, all patients (100%) had
pulmonary edema, 20 patients (95.2%) had
neurologic manifestations, and 16 patients (76.2%) had gastro-intestinal manifestations. During ICU stay, 18 patients (85.7%) received
mechanical ventilation (MV). The median duration of MV was 3 days (IQR: 2-4). The median duration of
dobutamine administration was 4 days (IQR: 3-5). Cardiac index at baseline was 2.7 L/min/m2 (IQR: 2.3-3.2). Under
dobutamine at 5, 10 and 15 μg/kg/min, it was 3.6 (IQR: 3.2-3.9), 4.0 (IQR: 2.9-4.8), and 4.1 (IQR: 3.6-4.9) respectively. Arterio-venous
oxygen difference at baseline was 6.0 ml/dl (IQR: 5.0-7.0). Under
dobutamine at 5, 10 and 15 μg/kg/min, it was 6.1 (IQR: 4.7-6.4), 3.9 (IQR: 3.4-4.3), and 3.9 (IQR: 3.1-4.7) respectively. The
length of stay in ICU was 4 days (IQR: 4-5) and 2 patients died during ICU stay (9.5%). Our study confirms that cardiac dysfunction following
scorpion envenomation in Tunisia improved well and safely under
dobutamine infusion. The optimal dose of
dobutamine to start with was between 5 and 10 μg/kg/min.