Autonomic Storm
Definition
The biphasic cardiovascular crisis of Indian red scorpion envenomation. An initial cholinergic phase of vomiting, salivation and bradycardia is followed by an adrenergic phase of hypertension, tachycardia, pulmonary oedema and myocarditis. The Bawaskar protocol uses prazosin to block the adrenergic surge.
- Cause
- Indian red scorpion envenomation
- Cholinergic phase
- Vomiting, salivation, bradycardia
- Adrenergic phase
- Hypertension, tachycardia, pulmonary oedema
- Treatment
- Prazosin, per the Bawaskar protocol
Common questions
Why does treatment specifically target the adrenergic phase rather than the earlier cholinergic phase?+
The adrenergic phase drives the cardiovascular collapse and pulmonary oedema that are the actual causes of death, so prazosin blocks that later surge even though symptoms begin earlier with cholinergic signs.
Could autonomic storm be mistaken for another medical emergency at first presentation?+
Yes, its cardiovascular and pulmonary signs can resemble other causes of acute pulmonary oedema or myocarditis, which is why a documented scorpion sting history is important to the correct diagnosis.
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