Venomous scorpions pose a great health hazard to children. The most common genera of scorpions found in Saudi Arabia are Androctonus crassicauda and Leiurus quinquestriatus. Scorpion venom is among the most potent of animal venoms. Stings by dangerously venomous scorpions do produce serious symptoms and have to be treated. Yet there is no unanimity about the treatment of scorpion sting. The suggested treatment regimes are: 1) no antivenom serum, 1 symptomatic treatment only; 2) 1 mL antivenom intramuscularly; 2 and 3) 5 mL intravenous antivenom in all cases. The object of the present study was to determine whether all scorpion stings need treatment with antivenom, or whether the cases can be categorized so that asymptomatic ones are not given antivenom. Materials and MethodsThis study was based on scorpion sting cases in children seen during a five-year period from 1991 to 1995 at the King Fahad Hospital, Al Baha, which is a referral hospital for the Al-Baha region of Saudi Arabia. The total number of cases seen was 386, with ages varying from one year to 12 years, the youngest of which was a baby of 10 months. The patients comprised 237 males and 149 females. Fifty-three of them were below two years, 125 were between two to five years, and 208 were between five and 12 years of age. Symptoms of Envenomation in Present SeriesA total of 169 patients (91%) out of a symptomatic group of 185 had developed symptoms by two hours of the sting, and by four hours, all cases (100%) had developed some definite local or general symptom. Those stings which were to show signs of envenomation, local or systemic, had done so within four hours.A total of 201 (52%) out of the 386 cases were completely asymptomatic. Twenty-nine (7.5%) had local symptoms like pain, swelling, redness, and itching lasting for between two and four hours. Systemic involvement was seen in 156 cases (40%). General symptoms such as salivation, sweating, extreme irritability, agitation and excessive crying were present in 132 cases (32%). Priapism was present in 52 affected male children (22%). The symptomwise presentation, laboratory and radiological abnormalities are listed in Table 1.Cardiovascular and neurological complications cause the most morbidity and are major causes of mortality in scorpion envenomation. Neurological complications were the next most common feature, and were seen in 51 cases (13%). The main neurological complications were extreme agitation and disorientation, muscular spasms, seizures, coma and cerebral edema, which is the most dreaded complication. A girl of four years who presented to hospital in a comatose condition after about six hours of envenomation died of cerebral edema. Hypersensitivity Reactions to Antivenom SerumA total of 182 patients (163 symptomatic and 19 asymptomatic) were given 5 mL antivenom intravenously. Reactions were seen in 25 patients (13.7%), with minor transient skin reactions in 23 (12.6%) of them. In two patients (1%), the reactions were more serious, such as severe urticaria, periorbital edema, cough,...
Episodes of unconsciousness, syncope, convulsions, or vertigo are often labeled as epilepsy and antiepileptic drugs are inappropriately used after cursory examination. Cardiac causes for such attacks should always be considered and an electrocardiogram (ECG) should always be a part of the workup in such cases. A male who was having attacks of syncope, cyanosis and convulsions precipitated by exercise and emotions is described, who was previously diagnosed as having epilepsy. ECG revealed that he had a long Q-T interval and he was also deaf. His sister was also found to be deaf with long Q-T intervals in her ECG and attacks of syncope. Other members of the family also had prolonged Q-T intervals in their ECGs.Attacks of unconsciousness, syncope or vertigo can many times pose diagnostic problems. The errors in correct diagnosis, evaluation and management of such attacks are due to inadequate history and clinical examination, as well as inappropriate investigations. Such attacks are often labeled as epilepsy, an overdiagnosed condition, and the label is wrongly applied to many children. The consequences are disastrous and effects of wrong treatment may compound the problem. Jeavons 1 found that 20% of his 470 patients did not have epilepsy; of these 93 patients, 35 had syncope.The causes of syncope or nonfebrile seizures are numerous but if syncope occurs in a previously well child who presents with atypical syncope which occurs during exercise or without typical circumstances associated with vasopressor syncope (such as heat or a crowded room), then disturbances of cardiac rate and rhythm have to be considered and ECG should be a part of the workup. Too frequently, attacks of loss of consciousness are branded automatically as epilepsy and patients are put on anti-epileptic treatment. We present a case below where, after perfunctory history and examination, the child was subjected to electroencephalogram (EEG) examination, diagnosed as epilepsy, and put on carbamazepine. In actual fact, the child had a cardiac conduction defect and deafness (Jervell and Lange-Nielsen syndrome), and on further exploration, it appeared that the younger sister of this child also had the same condition, and other members of the family had prolonged Q-T intervals in their electrocardiograms. Case History
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