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Severe scorpion envenomation in children: Management in pediatric intensive care unit
Mehmet Bosnak1, Hayri Levent Yilmaz, Aydin Ece
1Department of Pediatrics, Pediatric Intensive Care Unit, Dicle University Medical School, Diyarbakir, Turkey. mbosnak@dicle.edu.tr
Insights
Scorpion stings in children can cause severe complications. Antivenin and prazosin may be less effective if hospital admission is delayed for severe scorpion envenomation.
Area of Science:
- Pediatric Intensive Care
- Toxicology
- Public Health
Background:
- Scorpion envenomation poses a global public health challenge, particularly for children who face higher risks of severe cardiac, respiratory, and neurological issues.
- Pediatric intensive care units (PICUs) manage severe cases, necessitating evaluation of treatment efficacy.
Purpose of the Study:
- To assess the impact of antivenin and prazosin on the prognosis of children with severe scorpion envenomation admitted to the PICU.
- To analyze clinical characteristics, laboratory findings, and treatment outcomes in pediatric scorpion sting cases.
Main Methods:
- Retrospective analysis of standardized medical records for 45 children hospitalized in PICU with severe scorpion stings.
- Evaluation of general characteristics, clinical and laboratory data, treatment strategies, and patient prognosis.
Main Results:
- The study included 45 children (mean age 6.1 years), with the majority stung by Androctonus crassicauda on the foot-leg.
- Common symptoms included cold extremities, excessive sweating, and tachycardia. Elevated leukocyte counts and serum markers (glucose, LDH, CPK, INR) were observed.
- Two deaths (4.4%) occurred due to pulmonary edema, despite antivenin and prazosin, in critically ill patients requiring mechanical ventilation.
Conclusions:
- Current management involves antivenom and PICU surveillance for early intervention in life-threatening complications.
- Aggressive, organ-specific medical management can be effective.
- Delayed hospital admission may diminish the beneficial effects of antivenom and prazosin in severe scorpion stings.
Background:
Scorpion envenomation is a common public health problem worldwide and children are at greater risk of developing severe cardiac, respiratory and neurological complications. The aim of this study was to evaluate the effects of antivenin and/or prazosin use on prognosis of scorpion-envenomed children admitted to pediatric intensive care unit (PICU).
Methods:
The standardized medical records of 45 children hospitalized with severe scorpion sting in PICU were retrospectively evaluated. General characteristics of the children, clinical and laboratory findings, treatment approaches and prognosis were evaluated.
Results:
The mean age of the patients were 6.1 +/- 4.1 years ranging between 4 month and 15 years. Male to female ratio was 1.8. Thirty-three (71.1%) cases of scorpion stings came from rural areas. Twenty-six (57.8%) of the patients were stung by Androctonus crassicauda. The most common sting localization was the foot-leg (55.6%). The mean duration from the scorpion sting to hospital admission was 4.5 +/- 2.6 hours. The most common findings at presentation were cold extremities (95.5%), excessive sweating (91.1%) and tachycardia (77.7%). The mean leukocyte count, and serum levels of glucose, lactate dehydrogenase, creatine phosphokinase and international normalized ratio were found above the normal ranges. Prazosin was used in all patients, dopamine in 11 (24.4%) and Na-nitroprusside in 4 (8.8%) patients. Two children died (4.4%) due to pulmonary oedema. These children, in poor clinical status at hospital admission, needed mechanical ventilation, and death occurred despite use of antivenin and prazosin in both of them.
Conclusion:
The current management of children with severe scorpion envenomation consists of administration of specific antivenom and close surveillance in a PICU, where vital signs and continuous monitoring enable early initiation of therapy for life-threatening complications. The aggressive medical management directed at the organ system specifically can be effective. Our data indicated that when admission to hospital is late, the beneficial effect of antivenom and/or prazosin is questionable in severe scorpion stings.
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