Pediatric scorpion and snake envenomation in Türkiye: clinical features, management, and outcomes

Scorpion stings and snake bites are significant public health problems in Türkiye, particularly among children. In Türkiye, Androctonus crassicauda and Mesobuthus eupeus scorpions often cause systemic neurotoxic effects, while Vipera species snake bites mainly result in local tissue injury and hematological abnormalities. These envenomations may lead to serious complications if not promptly recognized and managed. We describe the clinical features, treatment, and outcomes of pediatric envenomations caused by scorpions and snakes.

This retrospective study included pediatric patients admitted to a tertiary care center's emergency department from January 2020 to April 2022 due to scorpion stings and snake bites, with follow-up data reviewed through early 2023. Demographics, clinical symptoms, laboratory results, treatment modalities, antivenom use, intensive care unit admissions, and outcomes were analyzed. Length of stay was recorded from admission to discharge in full calendar days as documented in the electronic medical record.

Ninety-five pediatric patients were included: 74 with scorpion stings and 21 with snake bites. The median age was nine years (IQR 5-14 years), with 35% female. Scorpion stings primarily caused systemic manifestations including vomiting, sinus tachycardia, supraventricular tachycardia, and sweating, while snake bites mostly led to local symptoms including redness, edema, and ecchymosis, along with hematologic abnormalities. Of the 11 pediatric patients who received antivenom, six had snake bites and five had scorpion stings. Twelve underwent pediatric intensive care admission. Median hospital stay was two days, and no mortality occurred.

Snake bites primarily resulted in local manifestations, whereas scorpion stings more frequently produced systemic symptoms. Pediatric intensive care admission and the need for supportive interventions differed according to both the type and severity of envenomation. The overall favorable clinical course observed in our patients likely reflects early presentation and the timely application of standardized supportive management.

Pediatric envenomations by indigenous scorpions and snakes in Türkiye had good outcomes. A minority received scorpion or snake antivenom. Most children were managed in a general pediatric ward. Systemic symptoms characterized scorpion stings, while local tissue injury typified snake bites.