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Scorpion Envenomation

Scorpion Sting


Presentation

  • Abstract The clinical presentation of 32 children with scorpion envenomation was analysed. The most common presentation was cold, clammy extremities with normal blood pressure.[ncbi.nlm.nih.gov]
Hypoxemia
  • Transient hypoxemia without evidence of end-organ dysfunction was documented in 4 patients during midazolam therapy.[ncbi.nlm.nih.gov]
  • In patients receiving mechanical ventilation, arterial hypoxemia was defined as a PaO 2 /FiO 2 ratio 300.[em-consulte.com]
  • […] including serum electrolytes, blood urea nitrogen, and creatinine; a liver panel; serum creatine kinase; and urinalysis. 1 These tests help to identify potential end-organ toxicity and rhabdomyolysis. 1 If the patient exhibits signs and symptoms of hypoxemia[journals.lww.com]
Congestive Heart Failure
  • All patients had a hemodynamic profile of acute congestive heart failure (mean PAOP 24 /- 2 mmHg; mean SVI 22 /- 7 ml/m2; mean CI 2.5 /- 0.5 l/min/m2). However, SVR were not increased (mean 22 /- 3 U/m2).[ncbi.nlm.nih.gov]
  • Sustained reduction of cardiac impedance and preload in congestive heart failure with antihypertensive vasodilator prazosin N Engl J Med 1977 ; 297 : 303 -7. View Abstract[bmj.com]
Aspiration
  • Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy.[ncbi.nlm.nih.gov]
  • 5.7 years 2.5 years 4.0 years 0.001; 0.024 * Grade IV 24 (41%) 14 (87%) 76 (93%) † Respiratory Distress 3% 56% 38% † Mean Vials Used 0 3.25 1.83 † Mean ED LOS 261 min 253 min 259 min 0.839 Hospitalization 3.4% 0 8.5% 0.167 Intubation 0 0 2.4% 0.607 Aspiration[aliem.com]
  • These will not only aggravate the respiratory depression but may increase the risk of vomiting and aspiration. However, sedation may be indicated to allow intubation and ventilation.[cmej.org.za]
Respiratory Disorders
  • Neurological, cardiovascular and respiratory disorders were uncommon. The global mortality recorded was 10 per 1000 cases. In conclusion, we propose that this information is beneficial for health education and prevention of scorpion sting cases.[ncbi.nlm.nih.gov]
Regurgitation
  • Left ventricle was hypokinetic in all patients with transient mitral regurgitation present in five patients. Left ventricular systolic function was markedly depressed (FS 12 /- 6%; EF 26 /- 12%).[ncbi.nlm.nih.gov]
  • The complications observed due to scorpion sting in this patient were myocarditis, mild mitral regurgitation, left ventricle dysfunction, hypotension, shock, acute kidney injury, bilateral pneumonia.[casereports.in]
  • Mild and moderate mitral regurgitation were present in 10 (25%) and in 3 cases, respectively. There was no previous history of cardiac disease in these patients. Prazosin was administered in 18 (45%) patients.[smjonline.org]
Left Ventricular Dysfunction
  • Severe envenomation produces predominant left ventricular dysfunction with normal systemic vascular resistance manifesting as pulmonary oedema or severe hypotension depending on the fluid balance.[ncbi.nlm.nih.gov]
Miosis
  • The other neurological signs observed were: agitation in 709 patients (74.6%), squint in 119 patients (12.5%), bilateral miosis in 43 patients (5%), and a bilateral mydriasis in 16 patients (1.7%).[ncbi.nlm.nih.gov]
  • Parasympathetic signs are as follows: Bronchoconstriction Bradycardia Hypotension Salivation, lacrimation, urination, diarrhea, and gastric emesis (SLUDGE) Rhinorrhea and bronchorrhea Goose pimple skin Loss of bowel and bladder control Priapism Dysphagia Miosis[emedicine.medscape.com]
Muscle Twitch
  • Advanced symptoms are : 1) muscle twitching (myoclonus?) 2) motor hyperactivity 3) incoordination (ataxia?)[members.tripod.com]
  • Poisoning caused by cholinesterase inhibitors Organophosphate as well ascarbamate poisoning and scorpion envenoming can cause a state of anxiety and restlessness, muscle twitching, increased oro-pharyngeal secretions, decrease in motor power, raised blood[cmej.org.za]
Neurologic Manifestation
  • There were 558 patients (81.5%) in the grade III group (with cardiogenic shock and/or pulmonary edema or severe neurological manifestation [coma and/or convulsion]) and 127 patients (18.5%) in the grade II group (with systemic manifestations).[ncbi.nlm.nih.gov]
Akinesia
  • Echocardiography was used for the assessment of left ventricular (LV) ejection fraction (EF) and regional wall motion (WM) by using a semi-quantitative score (0 normal, 4 akinesia). A 16-segment LV model was used.[ncbi.nlm.nih.gov]
Flaccid Paralysis
  • Most patients will, however, rapidly progress to a state of complete flaccid paralysis within 1 - 4 hours.[cmej.org.za]

Workup

Normal Chest X-Ray
  • These patients had normal chest X-rays and normal echocardiograms. Plasma norepinephrine was not elevated (188 /-180 pg/ml).[ncbi.nlm.nih.gov]
Bilirubin Increased
  • Pallor sign was correlated with a state of shock and/or low level of hemoglobin, associated or not to bilirubin increase. Fatalities (7.3%), presenting toxic myocarditis, had lowest count of lymphocytes ( 4.2%) in comparison to survivors.[ncbi.nlm.nih.gov]
Thrombocytosis
  • Multivariate analysis of laboratory parameters indicated that the most predictive factor for clinical severity is thrombocytosis (odds ratio 23.9; 95% CI: 1.6-353.5, P .021).[ncbi.nlm.nih.gov]
Decreased Platelet Count
  • Prolonged BT/CT, decreased platelet counts, prolongation of PT and APTT with positive fibrinogen degradation products (FDP) D-dimer and CT scan findings of multiple cerebral haemorrhagic infarct indicating the presence of disseminated intravascular coagulation[ncbi.nlm.nih.gov]
Ischemic Changes
  • Laboratory abnormalities include: hyperglycemia, leucocytosis, transient elevation of cardiac and pancreatic enzymes, ischemic changes in the ECG, and evidence of cardiac dysfunction on echocardiography.[ncbi.nlm.nih.gov]
Abnormal ECG
  • Clinical signs, abnormal ECG, and laboratory results were not discriminative between groups on arrival.[ncbi.nlm.nih.gov]

Treatment

  • Symptomatic treatment has been practiced earlier that failed to relieve the toxic effects of the venom.[ncbi.nlm.nih.gov]

Prognosis

  • In children, diarrhea and elevated liver enzymes are associated with poor prognosis.[ncbi.nlm.nih.gov]

Etiology

  • OBJECTIVES: Though scorpion envenomation is known to lead to acute myocarditis and a reversible decrease in left ventricular function, it has not been implicated as an etiological factor in idiopathic dilated cardiomyopathy.[ncbi.nlm.nih.gov]
  • They are organised into groups, and further divided into clinical, etiological or histopathological sub-types.[orpha.net]
  • In this study, etiological factors and treatments are discussed in a four year old boy that died due to a scorpion sting.[scinapse.io]
  • Etiology The causes of scorpion envenomation are primarily accidental. Scorpions are shy creatures and only sting if threatened, cornered, or disturbed (eg, being sat or stepped upon).[emedicine.medscape.com]
  • Macrophage recruitment into adipose tissue plays a key role in the etiology of diet-induced insulin resistance [24] .[journals.plos.org]

Epidemiology

  • OBJECTIVE: The aim of this study was to define the epidemiological, clinical, and laboratory manifestations of scorpion envenomation and to identify factors that are predictive of severe cases.[ncbi.nlm.nih.gov]
  • Scorpion sting syndrome: Epidemiology, clinical presentation. East Mediterr Health J 1997;3:83. 24. Pipelzadeh MH, Jalali A, Taraz M, Pourabbas R, Zaremirakabadi A.[amhsjournal.org]
Sex distribution
Age distribution

Pathophysiology

  • KEYWORDS: cytokines; inflammation; pathophysiology; scorpion envenomation [Indexed for MEDLINE] Free full text[ncbi.nlm.nih.gov]
  • Ausgewählte Seiten Seite 44 Seite 28 Seite 34 Seite 45 Seite 62 Inhalt Scorpion Antivenom 22 Cardiovascular Manifestations 39 Pathophysiology of Clinical Signs 75 Summary 102 Index 125 Urheberrecht Häufige Begriffe und Wortgruppen 24 hours action acute[books.google.de]

Prevention

  • We assessed the preventive and curative effects of scorpion antivenom by prevention of worsening grade or by improvement from grade II to grade I.[ncbi.nlm.nih.gov]

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