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Scorpion envenomation in children in southern India
S Das1, P Nalini, S Ananthakrishnan
1Department of Pediatrics, Jawaharlal Institute of Post-Graduate Medical Education and Research, Pondicherry, India.
Insights
Scorpion envenomation in children commonly causes cold extremities. Early supportive care is crucial for reducing severe outcomes like myocarditis and encephalopathy, especially without specific antivenom.
Area of Science:
- Pediatric toxicology
- Cardiology
- Neurology
Background:
- Scorpion envenomation is a significant health concern in pediatric populations.
- Clinical manifestations can range from mild symptoms to life-threatening complications.
- Limited data exists on the specific cardiac and neurological impacts in children.
Purpose of the Study:
- To analyze the clinical presentation of scorpion envenomation in children.
- To identify common symptoms, complications, and outcomes.
- To evaluate the role of electrocardiography (ECG) in diagnosing myocarditis.
Main Methods:
- Retrospective analysis of clinical data from 32 children with scorpion envenomation.
- Clinical assessment of symptoms, vital signs, and neurological status.
- Cardiac evaluation including ECG, and biochemical markers such as serum free fatty acids, glucose, amylase, and electrolytes.
Main Results:
- The most frequent presentation was cold, clammy extremities with normal blood pressure.
- Myocarditis occurred in 50% of cases, and encephalopathy in 12.5%.
- ECG proved sensitive for detecting subclinical myocarditis; left ventricular dysfunction was transient. Elevated serum free fatty acids were noted in symptomatic patients.
Conclusions:
- Myocarditis and encephalopathy are the primary lethal complications of pediatric scorpion envenomation.
- In the absence of specific antivenom, prompt and aggressive supportive treatment is vital.
- Early supportive management significantly reduces morbidity and mortality associated with scorpion stings.
Abstract:
The clinical presentation of 32 children with scorpion envenomation was analysed. The most common presentation was cold, clammy extremities with normal blood pressure. Myocarditis was present in 16 children (50%) and encephalopathy in four (12.5%). Two children died. ECG was a sensitive indicator of myocarditis which was subclinical in four children. Left ventricular dysfunction was a transient phenomenon. Myocarditis and encephalopathy were the two lethal complications observed. Serum free fatty acid levels were elevated two to three-fold in all symptomatic patients. Blood glucose levels were only mildly elevated and serum amylase levels and electrolytes were normal in all the children. No specific antivenom was given. In the absence of specific antivenom, early and active supportive treatment reduces the morbidity and mortality due to scorpion envenomation.