The scorpion envenoming syndrome: a different perspective. The physiological basis of the role of insulin in scorpion envenoming

Death caused by scorpion envenoming (Buthidae family) is a common event in tropical and subtropical countries. Severe scorpion envenoming causes an autonomic storm resulting in a massive release of catecholamines, angiotensin II, glucagon, cortisol, and changes in insulin secretion. As a consequence of these changes in the hormonal milieu, scorpion envenoming results in a syndrome of fuel energy deficits and an inability of the vital organs to utilize the existing metabolic substrates, which causes myocardial damage, cardiovascular disturbances, peripheral circulatory failure, pulmonary oedema, and many other clinical manifestations alone or in combination, producing multi-system-organ-failure (MSOF) and death. Insulin-glucose infusion or antivenom administration through the release of insulin seems to be the physiological basis for the control of the metabolic response when that has become a determinant to survival of scorpion sting victims.