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.