This document describes a retrospective study of 25 children admitted to a hospital in Chhattisgarh, India with scorpion envenomation. The majority of cases occurred in rural areas from June to September and involved boys under 10 years old. Common symptoms included hypertension, sweating, vomiting and fever. Prazosin was the primary treatment and most cases responded well with complete recovery. Timely administration of prazosin was found to be important for reducing morbidity.
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1. CLINICOPATHOLOGICAL PROFILE OF
SCORPION ENVENOMATION IN
CHILDREN OF CHHATTISGARH REGION
MEETA SACHDEV
G.MALINI
DEPTT. OF PEDIATRICS
JLN HOSPITAL & RESEARCH CENTRE; BHILAI
2. INTRODUCTION
Scorpion sting:
• Acute life-threatening, time-limiting
emergency.
• True incidence not known.
• Children are frequent victims.
• Case fatality:- 3-22 % (hospitalized
children).
3. INTRODUCTION
• Commonest species :- Mesobuthus tamulus
(red scorpion) & Palamneus swammerdam
( black scorpion).
• Clinical picture evolves in 30 minutes to 6 hrs.
• Cardiovascular effects are prominent.
• Pulmonary edema & cardiogenic shock- major
causes of death.
9. AIMS & OBJECTIVES
• To evaluate various demographic & clinical
parameters.
• To analyze significant factors related to
severity.
• To assess efficacy & role of early
administration of prazosin.
• To formulate & facilitate the strategy for
comprehensive care & management of cases.
10. SUBJECT & METHODS
• TYPE OF STUDY : RETROSPECTIVE
• TIME FRAME : JAN 2008 – SEP 2010
• NO. OF SUBJECTS : 25
• AGE GROUP : UPTO 15 YEARS
• INCLUSION CRITERIA : H/O SCORPION
STING
21. NO OF PATIENTS
ST
10
12
0
2
4
6
8
ER
O
ID
S
AV 10
IL 8
DO
PA
M
IN
E
2
LA
SI
DE X
2
RI
PH
YL
LI
NE
1
PR
AZ
O
SI
N
1
TREATMENT HISTORY
22. TIME LAPSE
8%
32% <3 HRS
24%
3-6 HRS
6-12 HRS
>12 HRS
36%
Variable Mean SD Minimum Maximum
Time Lapse 5.9800 5.6374 0.5000 27.000
23. % OF PATIENTS
LO
C
100%
0%
20%
40%
60%
80%
AL PA
C
HA IN
N
G
120% 100%
VO ES
M
8%
SA ITI
LI NG
DI VA
60%
73.6 %
TI
AP O
H N
O
R
32%
ES
PR IS
IA
80%
PI
91.1 %
AL SM
T.
CO SE
44%
NV N
U S
LS
32%
SIGNS & SYMPTOMS
DY ION
SP
8%
N
EA
40%
24. CLINICAL SIGNS
20.5 % 95.5 %
100% 29.6 % 77.7 % 24.5 %
88%
90% 80%
80% 72%
% OF PATIENTS
64% 61.5 %
70%
60% 52%
48%
50% 38 %
40%
30% 24% 20%
20% 12%
10%
0%
IA
EA
Y
N
R
N
VE
TS
12
ER
O
VE
RD
O
9-
O
EP
SI
SI
SI
PH
FE
N
A
N
CS
N
N
CR
SP
YC
TE
TE
TE
RI
G
DY
CH
PE
O
R
PO
RM
PE
TA
HY
LD
HY
NO
CO
41. CONCLUSION &
RECOMMENDATIONS
• Majority of the children develop severe
manifestations of scorpion envenomation.
• Close monitoring is essential.
• Time lapse between sting & administration of
prazosin determines outcome.
42. CONCLUSION &
RECOMMENDATIONS
• Prazosin should be given as an immediate
measure.
• Most of the cases with myocardial
dysfunction respond to dobutamine
infusion.
• Ventilatory support in cases of severe
pulmonary edema, refractory shock &
cerebral involvement may reduce
mortality.
44. REFERENCES
• Bouaziz m et al. Epidemiological, clinical characteristics and
outcome of severe scorpion envenomation in South Tunisia:
multivariate analysis of 951 cases.Toxicon 2008 Dec
15;52(8):918-26.
• Bosnak M et al.Severe scorpion envenomation in children:
Management in pediatric intensive care unit. Hum Exp
Toxicol. 2009 Nov;28(11):721-8.
• Bawaskar HS,Bawaskar PH.Indian Red Scorpion
Envenoming.Indian j Pediatr 1998;65 :383-391.
• Bawaskar HS ,Bawaskar PH.Utility of scorpion antivenin vs
Prazosin in the management of severe Mesobuthus tamulus
(Indian red scorpion) envenoming at rural setting.J Assoc
Physicians India.2007 Jan;55:14-21.
45. CRITICAL CARE ISSUES
Myocardial dysfunction & blood
pressure.
• Dobutamine (5-15 mcg/kg/min).*
• Sodium nitroprusside (0.3-5 mcg/kg/min).**
• Nitroglycerine (0.5-5mcg/kg/min).***
* Elatrous et al Dobutamine in severe scorpion envenomation. Chest 1999;
116:748-753.
** Bawaskar HS,Bawaskar PH.Prazosin for vasodilator treatment of acute
pulmonary edema due to scorpion sting.Ann Trop Med Parasitol 1987;1:719-
723.
*** P.Narayan et al.Nitroglycerine in scorpion sting with decompensated
shock.Indian Pediatrics 2006;43:613-617.
46. CRITICAL CARE ISSUES
Pulmonary edema
• Decreased intravascular volume can coexist
with pulmonary edema.
• Dynamic state.
• Diastolic dysfunction of left heart.
• Chest X-ray : sensitive & easily available tool.
• Clouding of consciousness : indicates shock.
• Severe cases may require ventilation.
• 30 minutes -3 hrs.