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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 2  |  Issue : 2  |  Page : 131-135

Scorpion envenomation in children and its management


1 Department of Pediatrics, Narayana Medical College Hospital, ChinthareddyPalem, Nellore, Andhra Pradesh, India
2 Department of Medicine, Narayana Medical College Hospital, ChinthareddyPalem, Nellore, Andhra Pradesh, India
3 Department of Forensic Medicine, Narayana Medical College Hospital, ChinthareddyPalem, Nellore, Andhra Pradesh, India
4 Department of Pharmacology, Narayana Medical College Hospital, ChinthareddyPalem, Nellore, Andhra Pradesh, India
5 Department of Neurosurgery, Narayana Medical College Hospital, ChinthareddyPalem, Nellore, Andhra Pradesh, India

Date of Web Publication11-Nov-2014

Correspondence Address:
M Rajesh Kumar
Department of Medicine, Narayna Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-4848.144300

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  Abstract 

Introduction: The present study was aimed to describe our experience with epidemiological characteristics, management options, and outcome of scorpion envenomation in children. Materials and Methods: The present retrospective study was conducted at Narayana Medical College and Hospital. The epidemiologic details including geographical locality of the event, age distribution, gender, and sting sites were noted in all hospitalized children with scorpion bite injury. Results: During the study period, a total 52 children were managed for scorpion sting. Mean age was 8.87 years. Male children were commoner victims of scorpion sting. Scorpion sting had bimodal pattern. Prazocin was used in 25 children. There was evidence of pulmonary edema in 23 cases. Seven patients required elective ventilation, and 5 of them could be weaned off within 72 hours. Mean hospital stay was 3.69 days. Two children expired in the present series. Conclusion: In present study, there was bimodal distribution of the scorpion sting cases, male children were more affected, and almost all of them improved with good outcome. We did not use anti-venin in the present study. The data from the study will serve not only to create heightened public awareness about scorpion envenomation but also to develop public awareness strategies and preventive measures.

Keywords: Children, envenomation, scorpion sting, scorpion, scorpion envenomation


How to cite this article:
Bharath R V, Kumar M R, Subrahmanyam B V, Rammohan P, Agrawal A. Scorpion envenomation in children and its management . Arch Med Health Sci 2014;2:131-5

How to cite this URL:
Bharath R V, Kumar M R, Subrahmanyam B V, Rammohan P, Agrawal A. Scorpion envenomation in children and its management . Arch Med Health Sci [serial online] 2014 [cited 2019 Oct 15];2:131-5. Available from: http://www.amhsjournal.org/text.asp?2014/2/2/131/144300


  Introduction Top


Scorpions are a group of arthropods belonging to the family Buthidae, which are potentially dangerous to humans. [1],[2] Due to their high incidence, scorpion envenomation is an important and serious health problem in many tropical and subtropical countries with a potential of severe and often fatal clinical manifestations among children. [2],[3],[4],[5],[6],[7],[8],[9],[10] The present study was aimed to describe our experience with epidemiological characteristics, management options, and outcome of scorpion envenomation in children.


  Materials and Methods Top


The present retrospective study was conducted at Narayana Medical College and Hospital. A total 52 children were included in the study. The epidemiologic details including geographical locality of the event, age distribution, gender, and sting sites were noted in all hospitalized children with scorpion sting bite injury. Details regarding local and general symptoms, site of sting were recorded in a pre-designed proforma. Details of local and general symptoms including pain, swelling, redness, itching, salivation, and sweating were noted. Details of any cardiovascular and neurological complications were noted. Data recorded for each case included, sex, age, weight, data related to the sting site, time elapsed from the accident to first medical attention, clinical symptoms, and vital signs at the moment of arrival, 30 min later and then every hour until the patient was discharged from the Hospital. Details of treat­ment, time spent in the hospital, evolution of envenoming, and any complications were also recorded. Laboratory investigations were performed in all children and included hemoglobin, total white blood cell count, platelet count, prothrombin time, serum glucose, urea, creatinine, liver function tests (alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, lactate dehydrogenase), sodium, potassium, chloride, and calcium. Electrocardiography was performed in all cases. X-ray chest and 2D echocardiography were used in all cases. The treatment of scorpion envenomation consisted of non-specific or supportive care. Local treatment consisted of 2% Xylocaine (without adrenaline) at the site of sting for pain relief. Prazosin was administered according to blood pressure and severity of envenomation. It was repeated as and when indicated. Those patients with cardiac dysfunction who did not respond to Prazosin received digoxin and diuretics. Injection Dobutamine was administered in patients with cardiogenic shock. We did not use anti-venom in any patient. Data were analyzed using the PSPP software.


  Results Top


During the study period, a total 52 children were managed for scorpion sting. Mean age was 8.87 years (minimum 2 years and maximum 18 years, SD ± 4.871 years). Male children were commoner victim of scorpion sting [Figure 1]. Scorpion sting had bimodal pattern more in cold and rainy weather [Figure 2]. Clinical details of the patients are shown [Table 1]. Most of the children (47) belonged to non-farmer (school going) group. Site of bite was lower limb in 37 and upper limb in 15 cases. Most of the bites occurred during day time (34 cases). Most of the children (41 cases) did not receive first aid before reaching to our hospital. Maximum children (34 cases) could reach hospital within 6 hours of the scorpion bite. Most of them (33 cases) were conscious at the time of presentation to emergency room. Thirty-four children had tachycardia; in 15 children, the pulse rate was normal and in three cases, pulse was not palpable. Twenty-three children had hypotension at the time of presentation and 9 children had hypotension. Forty-three children had tachypnea at the time of presentation to emergency room. Four children had priapism. Dyspnea was present in 17 cases. Ten children had history of vomiting. Eighteen children had excessive sweating, and 29 children had cold extremities. Local pain was the presenting complains in 45 children. Investigations showed leukocytosis in 15 children, hyper acute T wave in 1, low voltage complex in 1, ST elevation in 1, T wave inversion in 1, and tall "T" wave in 5 children respectively. Diastolic dysfunction was present in 21 children. Mild MR was seen in 10 children and moderate MR in 9 cases. Prazocin was used in 25 children. There was evidence of pulmonary edema in 23 cases. Seven patients required elective ventilation, and 5 of them could be weaned off within 72 hours. Mean hospital stay was 3.69 days (minimum 1 day and maximum 9 days, SD ± 2.131 days). Two children were expired in present series.
Figure 1: Age and sex distribution

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Figure 2: Month wise distribution of cases

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Table 1: Clinical details of the patients

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  Discussion Top


Scorpions are shy creatures, active at night during the hot season, but often live in houses or near inhabited areas, probably associated with the high incidence of scorpion sting in children. [1],[11],[12] The finding in present study states that male children are more involved than female is consistent with many other studies where similar findings were observed. [2],[6],[8],[13],[14],[15],[16],[17],[18] It has been attributed to the fact that boys probably go outside more commonly and play in places where scorpions live, [15],[16] and their higher inquisitive nature and risk-taking behavior. [15] It has been shown that the severity of scorpion envenomation is more in children, and it may be due to the fact that, for the same quantity of venom inoculated, the serum levels of venom will be higher in children than in adult patients, [19] and also it is possible that there is higher uptake in the heart and other organs. [20],[21],[22],[23]

Scorpion stings usually occur at night [10],[20] and mostly involve the extremities. [7],[9],[15],[18],[24] Few studies have reported incidence in upper limbs, [7],[9] and others have reported more in the lower limbs. [8],[12] The scorpion sting can occur in children in the head, neck, and other locations of the body at sleep or rest due to putting on clothes without checking them or not checking bed mattresses. [9],[23] In our study, there was bimodal pattern of scorpion sting reflecting differences in environmental conditions (hot and humid months) and socio-economic structure in rural areas (children walking barefoot) and lifting up stones in a non-­controlled manner. [2],[12],[15],[17],[24],[25],[26]

The systemic manifestations of scorpion envenoming result from the release of neu­rotransmitters in response to the actions of the toxin on sodium channels causing an adrenergic or cholinergic syndrome leading to a range of clinical pictures according to the species of scorpion and occurs in less than a third of victims of scorpion stings. [1],[5],[8],[24],[27],[28],[29],[30],[31],[32] The unopposed effects of alpha-receptor stimulation can lead to suppression of insulin secretion, hyperglycemia, and free radical accumulation causing injury to the myocardium. [8],[24],[29],[30],[31],[32] Clinical features can be localized (pain, hyperemia, edema, and numbness) and systemic effects (hyperthermia, nausea and vomiting, tachycardia, shivering and lethargy). [1],[2],[7],[33] Severe scorpion envenomations can result in cardiovascular, pulmonary, and neurological manifestations and can be life-threatening due to myocardial dysfunction, shock, pulmonary edema, or hyperten­sive encephalopathy. [19],[28]

The mainstay of treatment of scorpion sting is supportive care, symptomatic relief, and the use of specific scorpion anti-venom. [1],[8],[15],[29],[31],[34] Mild symptoms can be controlled with analgesics and anti-histamines in the majority. [8],[15],[29],[31],[34],[35],[36] In one study, most of the patients could be treated symptomatically, and only in one third cases, anti-venin was administered. [2] In another study, it was found that there was no evidence of benefi­cial effects of routine administration of scorpion anti-venom to stung patients, irrespective of clinical severity. [35],[37] The use of Prazocin has been shown to neutralize the adverse effect of catecholamine released in the brain. [38] Oral prazosin and appropriate use of dobutamine with avoidance of atropine, excessive diuretics, steroids, and anti-histamines may be helpful to hasten the recovery in severe scorpion sting victim. [29]


  Conclusion Top


In present study, there was bimodal distribution of the scorpion sting cases, male children were more affected, and almost all of them improved with good outcome. We did not use anti-venin in the present study.

 
  References Top

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