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 Table of Contents  
ORIGINAL ARTICLE
Year : 2020  |  Volume : 9  |  Issue : 1  |  Page : 31-32

Profile of scorpion sting in children admitted in the pediatric intensive care unit


Department of Pediatrics, MGM Hospital and Medical College, Navi Mumbai, Maharashtra, India

Date of Submission22-Oct-2019
Date of Decision13-Dec-2019
Date of Acceptance27-Dec-2019
Date of Web Publication06-Nov-2020

Correspondence Address:
Dr. Jeetendra Gavhane
Department of Pediatrics, MGM Hospital and Medical College, Kamothe, Navi Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jpai.jpai_13_20

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  Abstract 


Introduction: Venomous scorpion sting is a medical emergency. The clinical manifestations vary widely between the children and adult group. Aims: The aims of the study were to study the profile of scorpion sting in children admitted in the pediatric intensive care unit (PICU). Materials and Methods: Sixty-one cases of scorpion sting admitted in PICU of MGM Medical College were studied. A detailed history was taken, and a thorough clinical examination was done in all patients. All patients with cold extremities, sweating, and tachycardia were given prazosin. Patients with features of shock were treated with oral prazosin plus dobutamine. Patients with features of shock and myocarditis were treated with prazosin plus dobutamine plus antiscorpion venom therapy. Results: Of 61 cases enrolled in our study, scorpion sting was more common in monsoon followed by summer season. The sting was more prevalent in the lower limb. The most common symptom was pain followed by cold extremities. Dyspnea due to pulmonary edema and bradycardia were less common. Tachycardia was frequently noted (80%). Two patients presented after 12 h had developed pulmonary edema and died. Conclusion: Prazosin had good outcomes in all patients with scorpion sting when administered at the time of admission. The study throws light on the common clinical features and complications of scorpion sting.

Keywords: Myocarditis, prazosin, pulmonary oedema, scorpion antivenom, scorpion sting


How to cite this article:
Bhargava A, Panchal S, Kharche S, Gavhane J. Profile of scorpion sting in children admitted in the pediatric intensive care unit. J Pediatr Assoc India 2020;9:31-2

How to cite this URL:
Bhargava A, Panchal S, Kharche S, Gavhane J. Profile of scorpion sting in children admitted in the pediatric intensive care unit. J Pediatr Assoc India [serial online] 2020 [cited 2020 Nov 25];9:31-2. Available from: http://www.indjpai.com/text.asp?2020/9/1/31/300097




  Introduction Top


Scorpion sting is common in suburban/rural areas in children playing in playgrounds or farmyards. It is a medical emergency and requires prompt critical medical attention. Envenomation by scorpions can result in a wide range of clinical effects, including cardiotoxicity, neurotoxicity, and respiratory dysfunction. Of 1500 scorpion species known to exist, about 30 are of medical importance. Although a variety of different scorpion species that exist, majority of them produce similar cardiovascular side effects. The annual number of scorpion sting cases exceeds 1.23 million, of which over 32,250 may be fatal.[1] Regimen including scorpion antivenom, vasodilators, inotropes, and intensive care management has been tried to alleviate the systemic effects of envenoming.


  Materials and Methods Top


Clinical data of all the patients were collected and analyzed for demographic variables (that included age and sex), signs and symptoms (that included salivation, excessive sweating, tachycardia, local pain, priapism in males, cool extremities, and hypertension), and treatment modalities (all cases were treated according to the treatment protocol of the institute). Patients with cold extremities, sweating, and tachycardia were treated with oral prazosin. Patients with features of shock were treated with oral prazosin plus dobutamine. Patients with features of shock and myocarditis were treated with prazosin plus antiscorpion venom therapy (ASV) plus dobutamine. All patients were monitored till the signs of recovery and outcome.


  Results Top


Of 61 cases, the age group that was most involved was between 0 and 5 years with 52% cases followed by 6–10 years age group with 34% cases. Scorpion sting was more common in males with 39 (64%) cases. Scorpion stings in our study were more common in monsoon season (56%) followed by summer season (34%). Seventy percent bites were in the lower extremities as compared to the upper extremities. In our study, 75% of the scorpion stings were during night time.

The signs and symptoms further revealed that pain was the most common symptom and was present in 93% of the cases, followed by cold extremities with 92% of the cases. Other signs that were commonly seen were sweating, tachycardia, and hypertension. Pulmonary edema and bradycardia were the least common findings with two cases [Table 1]. Both the cases presented to us after 12 h.
Table 1: Signs and symptoms

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Raised blood sugar was seen in all the patients at the time of admission [Table 2]. Forty-three (70%) patients had myocardial dysfunction with electrocardiograph findings of reduced voltage and tall t-waves. All these 70% of the patients had more than three times elevated creatine kinase MB levels and troponin T-levels were elevated in 32 (52%) patients. All 43 (70%) patients received a stat dose of prazosin on admission. Thirty (49%) patients required a repeat dose of prazosin. Patients with myocardial dysfunction required ASV and dobutamine in addition to prazosin.
Table 2: Laboratory investigations

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  Discussion Top


The present study evaluated 61 cases presented for 2 years. All patients reported red to yellow color of scorpion which is common in Mesobuthus tamulus species found in India and is the most toxic of thirty poisonous species.[2]

We studied only the pediatric age group and found majority in 0–5 years' age group. Pol et al. reported 2–7 years as the most involved group.[3] In our study, males were more affected than females. The other study shows a similar pattern. Goyffon et al. from Tunisia in their study show that scorpion sting victims were male in the maximum number.[4] The male predominance of scorpion sting may be due to the higher inquisitive nature of boys and boys go outside more commonly than girls, especially during night. The most common site of scorpion stings in the present study was the lower limb, which was similar to Pol et al., Bosnak et al., and Farhly et al.'s observations.[3] The incidence of scorpion sting is more during monsoon than another season. Majority of the sting occurred during night. This might be because of scorpions are active at night. The local symptom of scorpion sting includes pain at the site of sting (most common), followed by redness, swelling, itching, and numbness. The common systemic signs include cold extremities, sweating, and tachycardia. Myocardial dysfunction was seen in more than 50% of the patients. All patients had hyperglycemia. Cold extremities were reported in majority of patients in studies by Bawasker et al. and Biswal et al.[5] Two cases died, both due to complication of pulmonary edema. Case fatality rate in this study was 3.27%. Both of these cases presented after 12 h of scorpion sting.


  Conclusion Top


Scorpion sting envenomation is a common medical emergency among children. In our study, it was found that it is common in boys, predominantly in the lower limbs, during night time and during monsoon season. Timely referral and early therapy with prazosin, inotropes, antiscorpion and venom accordingly has a great impact on a favorable outcome.

Ethical approval

The study was approved by the institutional ethics committee.

Financial support and sponsorship

Nil

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chippaux JP, Goyffon M. Epidemiology of scorpionism: A global appraisal. Acta Trop 2008;107:71-9.  Back to cited text no. 1
    
2.
Mahadevan S. Scorpion sting. Indian Paediatr 2000;37:504-13.  Back to cited text no. 2
    
3.
Pol R, Vanaki R, Manaswini P. The clinical profile and the efficacy of Prazosin in scorpion sting envenomation in children of North Karnataka (India). J Clin Diagn Res 2011;5:456-8.  Back to cited text no. 3
    
4.
Goyffon M, Vachon M, Broglio N. Epidemiological and clinical characteristics of the scorpion envenomation in Tunisia. Toxicon 1982;20:337-44.  Back to cited text no. 4
    
5.
Biswal N, Bashir RA, Murmu UC, Mathai B, Balachander J, Srinivasan S. Outcome of scorpion sting envenomation after a protocol guided therapy. Indian J Pediatr 2006;73:577-82.  Back to cited text no. 5
    



 
 
    Tables

  [Table 1], [Table 2]



 

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