Clinical efficacy of l-carnitine in scorpion sting myocarditis: A randomized study

BackgroundScorpion sting is a public health problem in tropical and subtropical countries including India. Delay in recognition and the hypoxemia increase the morbidity and mortality (12–25%). Various therapeutic modalities were applied in the management of scorpion envenomation but the golden therapy is yet to emerge.Material and methodsForty consecutive patients were randomly assigned to l-carnitine or non-l-carnitine group. Patients in l-carnitine group were administered 1 g l-carnitine injection 8th hourly for five days followed by oral l-carnitine 2 g/day till complete recovery.ResultsThe mean time interval between the scorpion sting and clinical presentation was 12 h (range 2–24 h). Time interval was shorter than 4 h in 22.5% (9/40). At presentation it was hypotension (30, 75%) and tachycardia (36, 90%) in majority. CPK (≥200 mg/dl) was elevated in majority (84.8%, 28/33) and CPK-MB was elevated in 86.8% (33/38). Majority of the patients had LV function below 20%. All survivors had full recovery of LV function. Average time to normalization of LV function was 6.7 days. Significant reduction in LV end diastolic and end systolic volume and improvement in ejection fraction was observed in both groups (p < 0.01).ConclusionThis study showed that both groups are not significantly different and also could not rule out any beneficial effect of l-carnitine in the management of scorpion envenomation. Hence, l-carnitine could be a useful drug in patients with hypotension, and severe LV dysfunction.