Clinical Characteristics of Pediatric Scorpion Envenomation in the Aegean Region: An Experience of a Training and Research Hospital

Abstract

Amaç: Bu çalışmanın amacı Ege bölgesinde akrep tarafından sokulan çocukların klinik ve laboratuvar özelliklerini belirlemek ve ağır olguları öngörmede kullanılacak belirteçleri saptamaktı. Yöntemler: 2008 ile 2015 yılları arasında Ege bölgesinde akrep sokması nedeniyle hastanemize başvuran çocuk olgular geriye dönük incelendi. Olgular klinik şiddetlerine göre gruplandırıldı. Çocuk yoğun bakım ünitesine yatan ve genel pediyatri servisine yatan olguların klinik ve laboratuvar özellikleri karşılaştırıldı. Bulgular: Toplam 23 çocuk olgu (ortanca yaş: 60 ay, 25-75 persentil: 26-98 ay; en düşük yaş: 12 ay; en büyük yaş: 156 ay, kız/erkek: 12/11) değerlendirildi. Olguların %86,9'u hastanemize sevkli geldiler. On dört olguya (%60,9) başvurdukları ilk merkezde antivenom verilmişti. Ancak bu hastalarda intramüsküler antivenomun etkin olmadığı görüldü. En sık saptanan bulgular lokal eritem (%82,6), taşikardi (%65,2) ve takipne (%56,5) idi. Çocukların büyük çoğunluğu (%82,6) ağır klinik şiddete sahipti. Olguların %21,7'sinde otonomik fırtına, %8,7'sinde kalp yetersizliğine bağlı akciğer ödemi, %4,3'ünde kalp dışı akciğer ödemi, %4,3'ünde kalp yetersizliği gelişti. Olguların %60,9'u çocuk yoğun bakım ünitesine yatırıldı ve %13'ü mekanik ventilatöre bağlandı. Hiç bir olgu kaybedilmedi. Çocuk yoğun bakıma yatan olguların hastanemize daha geç geldiği (6 saate karşılık 3 saat) ve başvuru anında ölçülen serum glikoz düzeyinin daha yüksek olduğu (175 mg/dL'ye karşılık 107 mg/dL) saptandı (p<0,05). Sonuç: Ege bölgesinde akrep sokması çocuklarda ciddi klinik sonuçlara neden olabilmektedir. İntramüsküler antivenom uygulaması etkisiz gözükmektedir. Hastanemize ulaşma süresinin uzun olması ve başvuru anında yüksek serum glikoz saptanması çocuk yoğun bakıma yatırılma ihtiyacı ile ilişkili bulunmuştur. Anahtar Kelimeler: Akrep zehirlenmesi, antivenom, Ege bölgesi Introduction: The aim of this study was to define the clinical and laboratory manifestations of scorpion sting envenomation in childhood in the Aegean region of Turkey and to identify factors that are predictive of severe cases. Methods: Children admitted to our emergency department due to scorpion sting envenomation between 2008 and 2015 in the Aegean region of Turkey were evaluated retrospectively. The patients were grouped according to the clinical severity. Children admitted to pediatric intensive care unit and children admitted to general pediatric ward were compared in terms of clinical and laboratory features. Results: A total of 23 children (median age: 60 months; 25-75 percentile: 26-98 months; minimum: 12 months, maximum: 156 months; male/female: 12/11) were evaluated. 86.9% of cases were referred to our hospital. Fourteen patients (60.9%) were given antivenom via intramuscular route. However, intramuscular antivenom was found to be ineffective. The most common findings were local erythema (82.6%), tachycardia (65.2%) and tachypnea (56.5%). The majority of children (82.6%) had severe clinical severity. Autonomic storm developed in 21.7% of patients, heart failure due t...

Levosimendan treatment in a child with treatment-resistant left ventricular systolic dysfunction after scorpion sting

“…Cardiotoxicity occurs due to continuous beta‐receptor stimulation leading to cardiac fatigue and consequently causes a decrease in left ventricular function. Previous studies reported that delayed admission to the hospital and hypotension at the time of admission were associated with more severe clinical signs and myocardial dysfunction 8 , 9 …”

“…Previous studies reported that delayed admission to the hospital and hypotension at the time of admission were associated with more severe clinical signs and myocardial dysfunction. 8,9…”

“…Previous studies reported that delayed admission to the hospital and hypotension at the time of admission were associated with more severe clinical signs and myocardial dysfunction. 8,9 Although some investigators do not recommend antivenom for envenoming by medically important buthid scorpions, studies have shown the efficiency of antivenom in Turkey. 6,9,10 The study in the murine model suggest that an equine antivenom against A. crassicauda may be effective at least against L. quinquestriatus, a closely related congener of L. abdullahbayrami.…”

“…8,9 Although some investigators do not recommend antivenom for envenoming by medically important buthid scorpions, studies have shown the efficiency of antivenom in Turkey. 6,9,10 The study in the murine model suggest that an equine antivenom against A. crassicauda may be effective at least against L. quinquestriatus, a closely related congener of L. abdullahbayrami. 11 Scorpion antivenom should be administered as soon as possible in patients with systemic findings.…”

Evaluation of Scorpion Stings in Children

“…21 The closer the scorpion sting is to the head, the greater the severity of the poisoning. 14,18 A study conducted in Iran found that the LDH concentration was significantly higher in patients with severe scorpion stings compared to those with mild or moderate stings. 22 Another study conducted in Tunisia found that the LDH concentration was significantly higher in children with severe scorpion stings than in those with mild or moderate stings.…”