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Scorpion sting envenomation: complications and management
... Hence he had considered priapism as one of the premonitory signs of cardiac complications in case of scorpion sting. The priapism is more common in scorpion sting due to Buthus tamulus (30)(31)(32) . ...
... Scorpion sting can produce a syndrome of oliguria, anuria and/or hematuria, associated with puffiness of face. Acute renal failure has also been reported and could be due to toxin-induced acute tubular necrosis, immune complex deposition, disseminated intra vascular coagulation or rhabdomyolysis (31,41,42) . ...
... Pathology may be due to (31,41,42) decreased renal plasma flow (hypovolemia) and afferent arteriolar constriction, Toxin induced acute tubular necrosis, Immune complex glomerulonephritis, rhabdomyolysis, renal failure may result from venom induced excessive motor activity ...
... Hence he had considered priapism as one of the premonitory signs of cardiac complications in case of scorpion sting. The priapism is more common in scorpion sting due to Buthus tamulus (30)(31)(32) . ...
... Scorpion sting can produce a syndrome of oliguria, anuria and/or hematuria, associated with puffiness of face. Acute renal failure has also been reported and could be due to toxin-induced acute tubular necrosis, immune complex deposition, disseminated intra vascular coagulation or rhabdomyolysis (31,41,42) . ...
... Pathology may be due to (31,41,42) decreased renal plasma flow (hypovolemia) and afferent arteriolar constriction, Toxin induced acute tubular necrosis, Immune complex glomerulonephritis, rhabdomyolysis, renal failure may result from venom induced excessive motor activity ...
Scorpion stings are a major public health problem in many underdeveloped tropical countries, especially in rural parts of India. Patients often presents with life threatening complications. Envenomation due to scorpion sting results in various clinical manifestations. They range from mild local pain to diffuse intolerable pain of whole limb and body to sys-temic manifestation involving almost all systems, predominantly cardiovascular and may sometimes lead to death.
... Acute renal failure has also been reported and could be due to toxin-induced acute tubular necrosis, immune complex deposition, disseminated intra vascular coagulation or rhabdomyolysis. 31,41,42 ...
... Pathology may be due to 31,41,42 1. Decreased renal plasma flow Hypovolamia and afferent arteriolar constriction. 2. Toxin induced acute tubular necrosis. ...
Scorpion stings are a major public health problem in many underdeveloped tropical countries,
especially in rural parts of India. Patients often presents with life threatening complications.
Envenomation due to scorpion sting results in various clinical manifestations. They range from
mild local pain to diffuse intolerable pain of whole limb and body to systemic manifestation
involving almost all systems, predominantly cardiovascular and may sometimes lead to death.
... The generally accepted treatment is symptomatic treatment and antivenom administration [1]. Patients with systemic symptoms should be monitored and treated in the intensive care unit [7,8]. ...
Introduction
Scorpion sting in children is still a serious health problem today. Children are at greater risk of developing severe cardiac, respiratory, and neurological complications because of their low body weight. In this study, we retrospectively evaluated the demographical changes, complaints, clinical findings, and laboratory results of scorpion sting cases admitted to the pediatric emergency department.
Materials and Methods
The records of 72 patients who were followed up with the diagnosis of scorpion sting in the Dicle University Pediatric Emergency Department between 2013 and 2017 were retrospectively analyzed.
Results
The patients included in the study were between one and 15 years (7.64±4.04 years) and 43.1% were male, and 56.9% were female. While 65.3% of the cases lived in rural areas, 34.7% lived in the city center. The most common stung areas in the cases were the lower extremity (51.4%) and the upper extremity (34.7%). The most common complaints in the patients were 70.8% pain, 58.3% edema, 41.7% cold extremities, 23.6% sweating, 22.2% vomiting, and 12.5% excessive salivation. Of the cases, 71.4% had mild, 25.7% had moderate, and 2.9% had severe stages. Of the patients, 91.6% were given antivenom, 75.7% were given antihistamines, 74.3% were given steroids, 65.7% were given antibiotics, 64.3% were given analgesics, 44.3% were given tetanus vaccine, 2.8% were given erythrocyte suspension and 1.4% were given platelet suspension. In addition, 11.4% of the cases were given prazosin treatment. While 32.9% of the cases required intensive care, two patients died. A statistically significant difference was found between the glucose, urea, creatine, total protein, sodium, potassium, alanine aminotransferase, white blood cell count, red blood cell count, hemoglobin, hematocrit, neutrophil count values of the patients at admission and discharge.
Conclusion
Scorpion sting cases are still a significant health problem. The severe clinical course is more common in children. The management of patients with severe clinical forms is based on early recognition of the sting, antivenom serum administration, and cardiorespiratory and systemic support.
... Also, these envenomed children had heart failure manifestations of variable percentages as proved clinically in the form of dyspnea, orthopnea, raised jugular venous pressure, lower limb edema, congested liver, and cardiomegaly, and by imaging tools in the form of cardiomegaly in their chest X-rays and left ventricular systolic dysfunction using echocardiography, in the form of significant higher both LVEDD and LVESD with significant lower EF and FS. These findings were in line with many investigators (Biswal et al., 1993(Biswal et al., , 2006Abd El-Gawad et al., 2006;Sagarad et al., 2012a,b;Arivoli and Ganesh, 2015;Ismail et al., 2016;Kumar and Prasad, 2015). The severity of envenomation is mainly related to neurological and cardiorespiratory dysfunction (Farghaly and Ali, 1999;Osnaya-Romero et al., 2001;de Roodt et al., 2003). ...
In the present study, 45 children in Upper Egypt (less than 16 years old) were admitted to the Pediatric Intensive Care Unit for scorpion envenomation (SE).They were compared with 30 apparently healthy children of matching age and sex as controls. Out of the studied victims, 35 children (78 %) showed signs of severe envenomation, while 10 victims (22 %) showed signs of mild envenomation. The case fatality was 33%. The serum levels of cardiac markers, cardiac troponin T (cTnT) and I (cTnI), as well as the enzymatic activities of creatine kinase-MB (CPK-MB) and lactate dehydrogenase (LDH) were determined for both victims and controls. In addition, the serum levels of oxidative stress markers, nitric oxide (NO), malondialdehyde (MDA), superoxide dismutase (SOD), reduced glutathione (GSH) and zinc (Zn) were measured. Electrocardiography and echocardiography were done. All the envenomed victims showed significantly higher mean values of cTnT, cTnI, CPK-MB and LDH than control group. These cardiac markers were elevated in severe cases and in non survivors in comparison with mild cases and survivors respectively. Furthermore, the serum levels of NO and MDA were significantly higher while the serum levels of SOD, GSH and Zn were significantly lower in all envenomed victims than the controls (p<0.05 for all). There were no significant differences in the serum levels of oxidative stress markers among severe and mild cases or between survivors and non survivors
victims. There were no significant correlations between the serum levels of cardiac markers and the oxidative stress markers in envenomed victims. In
53 conclusions, oxidative stress occurs in scorpion envenomed children, but does not determine prognosis. Cardiac markers, but not the oxidative stress, remain the
most important determining factor for the severity and the outcome of SE.
Keywords: Cardiac markers; oxidative stress; scorpion-envenomation.
... ECG helps in diagnosis of fatal conduction disturbance, ischemia and very importantly tachycardia is the commonest finding usually seen with in first 4 hours and may persist for 24-72 hours.Bradycardia was noted in only 7 patients (10.2%) at admission but Biswalet al. reported bradycardia in 3.5% of cases. (8,9) Priapism was noted in nearly 1/3 rd [30.9%] of male children. But Bawaskar et al. has noted occurrence of this clinical symptom in as many as 10% of patients and hyperglycemia was documented in 85% of our cases, and this is similar to studies by Balasubramaniam et al. [10][11] Radiographic changes suggestive of pulmonary edema has been seen even within 3-4 hours of sting, even when asymptomatic as analyzed by various studies including Mahadevan et al..Pulmonary edema is a life threatening complication following scorpion sting by Mesobuthus tamulus species. ...
... The clinical manifestations of scorpion envenomation are vomiting, profuse sweating, cold extremities, pulmonary oedema and death [4,5]. The deaths in scorpion sting envenomation are attributed to cardiopulmonary complications like myocarditis and acute pulmonary oedema [6,7,8]. ...
Objective: This study was an evaluation of the pattern of presentation, the outcome and the efficacy of Prazosin in scorpion sting envenomation at a tertiary care hospital in Bagalkot, India. Methods: A total of 240 consecutive children were prospectively studied. The data included demographics, the time of presentation to the hospital, the clinical features, and the premedication which was given before the arrival of the subjects at the hospital, response to the oral Prazosin and the hospital outcome. Results: Local pain, sweating and peripheral circulatory failure were the common clinical presentations. Complications like acutepulmonary oedema, myocarditis, shock and encephalopathy were also seen. These were treated with a combination of Prazosin with either inotropes or vasodilators. Mortality was seen in 18 (7.5%) children. The usage of antihistaminics and steroids in these children led to higher mortality. Oral Prazosin, a postsynaptic alpha -1 blocker, is a highly effective drug for scorpion sting envenomation. Conclusion: Scorpion sting envenomation is an acute life threatening emergency and an early presentation to the hospital and an early intervention with Prazosin can hasten the recovery in the scorpion sting victim.
... 6 this may be because variation in the species and venom composition. 4,5,14 All the patients were treated symptomatically with supportive care as detailed in the methodology. Several studies have been published both far and against the use of antivenom. ...
... The clinical manifestations of scorpion sting envenomation are vomiting, sweating, cold extremities, pulmonary oedema and death [4,5]. Cardiopulmonary complications, mainly pulmonary oedema and shock, are the leading causes of death678. Echocardiography is an excellent tool in evaluating various parameters of the cardiac functions. ...
This study was to evaluate the predictive value of the cardiac troponins in scorpion sting myocarditis at a tertiary care hospital in Raichur, (Karnataka state) India.
A total of 84 consecutive patients were prospectively studied. The data included the demographics, the time of presentation to the hospital, the clinical features, the cardiac troponin levels and the echocardiographic findings.
12 patients with only local symptoms had troponin levels of less than 0.01μg/L. 12 patients with local and systemic symptoms without an echocardiac evidence of myocarditis had troponin values of 0.01 to 0.11 μg/L. 60 patients with an echocardiographic evidence of myocarditis had troponin levels of above 0.11 μg/L. 6 patients with severe myocarditis who required ventilator support or which led to death had troponin values which were higher than 10 μg/L.
High cardiac troponin levels predict myocarditis in scorpion sting envenomation and they can be a useful tool in guiding the therapy early.
Scorpion sting syndrome is a life threatening emergency in children and older individuals, especially, who are suffering from respiratory and/or cardiovascular diseases. Although there are mortalities from scorpion stings in Libya, but there is no management protocol for this medical emergency. The possible causes of these mortalities in Libya are late presentation of the patient, absence of a referral poison control center in Libya, and due to doctors' hesitation to use the available polyantivenom and the presence of deadly scorpion species especially in the southern part of the country.
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