الفهرس 
• Introduction & Aim of the workOnly 14 pages are availabe for public view
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Abstract
Scorpion envenomation represents a serious health problem with possibly fatal outcome especially in children. Routine management with scorpion antivenom is essential, however its efficacy declines gradually when cardiotoxicity develops.
This study was carried out to study the outcome of using prazocin and dobutamine beside scorpion antivenom in the management of scorpion envenomation.
A total of 102 patients with scorpion envenomation were available for this study during the period from June 2014 to December 2015. Patients were divided into 3 primary groups, thirty four per each group: group (I): received scorpion antivenom alone, group (II): received oral prazocin plus SAV and group (III): received SAV plus IV dobutamine.
Among the mentioned three groups, patients who were complicated with pulmonary edema were further classified into another three groups as following: group (IV): Eighteen patients from group (I) received prazocin and dobutamine plus SAV, group (V): Nine patients from group (II) received dobutamine plus SAV and group (VI): Ten patients from group (III) received prazocin plus SAV.
Patients in each group were clinically, biochemically and radiologically evaluated for manifestations of cardiotoxicity resulting from scorpion envenomation. Number of cases that developed pulmonary edema was significantly lower in patients who received prazocin and dobutamine respectively than in those who received SAV alone.
In patients who recovered without pulmonary edema prazocin revealed faster improvement in the clinically examined parameters, percentage of LVEF elevation in the 1st 48 hr following institution of therapy, normalization of CPK-MB levels, hospital stay and number of antivenom vials needed by each patient.
After development of pulmonary edema, dobutamine was superior on prazocin in earlier recovery of patients from pulmonary edema with significantly faster normalization of clinically examined parameters, diminished levels of LVEF %, normalization of CPK-MB levels, hospital stay and the number of vials needed by each patient with better survival.
Accordingly, adding prazocin followed by dobutamine is useful in the treatment of myocardial dysfunction following scorpion envenomation; however, prazosin has an edge over dobutamine in management of these cases in reducing the incidence of development of pulmonary edema, earlier recovery of clinical, biochemical and radiological effects of envenomation with subsequent shorter ICU stay and less mortality. Besides its efficacy, the low cost of therapy and ease of administration with prazosin makes it a better option than dobutamine infusion especially in initial stages, however when resistance to prazocin occurs dobutamine is considered lifesaving.
In this way, prazosin can be used initially then the patient is monitored for left ventricular failure, when the addition of dobutamine is essential to get the best results.