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ORIGINAL ARTICLE
Year : 2013  |  Volume : 16  |  Issue : 2  |  Page : 60-63

Scorpion envenomation and its management in adults


1 Department of Medicine, Narayana Medical College Hospital, Chinthareddy Palem, Nellore, Andhra Pradesh, India
2 Department of Pediatrics, Narayana Medical College Hospital, Chinthareddy Palem, Nellore, Andhra Pradesh, India
3 Department of Forensic Medicine, Narayana Medical College Hospital, Chinthareddy Palem, Nellore, Andhra Pradesh, India
4 Department of Pharmacology, Narayana Medical College Hospital, Chinthareddy Palem, Nellore, Andhra Pradesh, India
5 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddy Palem, Nellore, Andhra Pradesh, India

Date of Web Publication19-Jul-2013

Correspondence Address:
Meriga Rajesh Kumar
Department of Medicine, Narayna Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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DOI: 10.4103/1118-8561.115262

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  Abstract 

Background: We describe the epidemiology, clinical features, management, and outcome of adult patients of scorpion envenomation. Materials and Methods: This is a retrospective study involving a total of 40 patients conducted at Narayana Medical College and Hospital. All the patients had complete blood count, blood glucose, urea, creatinine, liver function test, urine examination, electrocardiography, X-ray chest, and two-dimensional echocardiography as and when indicated. Results: During the study period, a total 40 adult patients were managed for scorpion sting. Mean age was 34.93 ± 12.6 years. Farmers 34 (85%) cases were more commonly bitten by scorpion. Lower limbs (65%) were common site of sting than upper limbs. Stings were more frequent during daytime 27 67.5% vs. 32.5%). Only 12 patients (30%) received first aid before coming to our hospital. Many patients 28 (70%) reached the hospital within 6 h of scorpion sting. Most of the patients 32 (80%) were conscious. There was evidence of pulmonary edema in 15 (37.5%) patients. Eight (20%) patients required elective ventilation and one of the patients had fatal outcome giving an overall mortality of 2.5%. Mean hospital stay was 3.15 ± 1.67 days). Conclusion: Scorpion stings are more frequent in male farmers with most stings occurring in the lower limbs during the daytime in the study population. Local pain was the most common manifestation. Scorpion stings could nonetheless be associated with severe complications with fatal outcome. We recommend public awareness about preventive measures and early management of scorpion sting as measures of reducing scorpion sting related morbidity and mortality.

Keywords: Envenoming, outcome, scorpion sting, scorpion envenomation


How to cite this article:
Kumar MR, Bharath RV, Subrahmanyam BV, Rammohan P, Agrawal A. Scorpion envenomation and its management in adults. Sahel Med J 2013;16:60-3

How to cite this URL:
Kumar MR, Bharath RV, Subrahmanyam BV, Rammohan P, Agrawal A. Scorpion envenomation and its management in adults. Sahel Med J [serial online] 2013 [cited 2019 Oct 15];16:60-3. Available from: http://www.smjonline.org/text.asp?2013/16/2/60/115262


  Introduction Top


Scorpion sting is dreaded, yet neglected public health issue in the tropical and subtropical regions of the world with a significant morbidity and mortality. [1],[2],[3] Scorpion is commoner in rural parts of India and was associated with greater fatality rate in preprazosin treatment era. [4] The mechanisms underlying the effects of scorpion venom and its pharmacokinetics as well as the pharmacological basis of the therapeutic efficacy and of the commonly used antiscorpion venom drugs and attendant improved outcome have been well-documented. [1],[2],[3] In present study, we describe the epidemiologic, clinical features, management, and outcome of adult patients with scorpion envenomation.


  Materials and Methods Top


The present retrospective study was conducted from January 2009 to December 2012 at Narayana Medical College and Hospital, Nellore, Andhra Pradesh, India. A total 40 patients were included in the study. Details of local and systemic symptoms including pain, swelling, redness, itching, salivation, and sweating were recorded. Details of any cardiovascular and neurological complications were noted. All the patients had investigations including complete blood count, blood glucose, urea, creatinine, liver function test, urine examination, electrocardiography (ECG), chest X-ray, and two-dimensional echocardiography (performed in all cases and was repeated as and when necessary). The treatment of scorpion envenomation consisted of supportive care. Local treatment consisted of 2% Xylocaine (without adrenaline) infiltration at the site of sting for pain relief. Prazosin was administered in patients who had normal or high blood pressure. It was repeated as and when indicated. Those patients with cardiac failure who did not respond to prazosin received digoxin and diuretics. Injection dobutamine was administered in patients with cardiogenic shock. We did not use antivenom in any patient. Data were analyzed using the PSPP software (http://www.gnu.org/software/pspp/).


  Results Top


During the study period, a total 40 adult patients presented with scorpion sting to the emergency department and all were admitted. Mean age was 34.93 ± 12.6 years (range: 19-63 years). Male patients were commonly involved in scorpion sting than females [Figure 1]. Scorpion sting was more common during cold and rainy weather [Figure 2]. The clinical details of the patients are shown in [Table 1]. Farmers 34, (85%) were more commonly bitten by scorpion than individuals of other occupations. Lower limbs were more frequent sites of sting 26 (65%) of sting than upper limbs 13 (32.5%). In one case, the face was the site of sting. Stings were more frequent during the day than nighttime (67.5% vs. 32.5%). Only 12 (30%) patients received first aid before coming to our hospital. Most of the patients 28 (70%) reached the hospital within 6 h of scorpion sting. Most of the patients 32 (80%) were conscious. The other observed major presentations included tachycardia 21(52.5%) tachypnea 22 (55%), hypertension 12 (30%), and hypotension 9 (22.5%). Nine (22.5%) had history of vomiting. There was no patient with history of priapism. Ten patients had excessive sweating. Local pain was present in 39 (97.5%) patients. Leucocytosis was seen in 16 (40%). ECG showed bradycardia in hyperacute T wave and poor R wave progression each in one patient "T" wave inversion and tall "T" waves were seen in three patients, respectively. Diastolic dysfunction was seen in 12 (30%) cases. 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. There was evidence of pulmonary edema in 15 (37.5%) patients. Eight (20%) patients required elective ventilation and one had fatal outcome. Mean hospital stay was 3.2 ± 1.7days (range: 1-8 days).
Figure 1: Age and sex distribution

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Figure 2: Month-wise distribution of cases

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Table 1: Clinical details of the patients

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  Discussion Top


Scorpions are arthropods of the arachnid class and many species have been described, but only few are responsible for human toxicity. [2],[5],[6],[7],[8],[9],[10],[11] The scorpion is a nocturnal arthropod and it seeks protection from the heat during the day by sheltering under rocks or debris and unable to tolerate high temperatures. [6],[9] Hence, the increased incidence of scorpion sting incidence during the rainy season as in the current report. [2],[12],[13] here is also an increased frequency of scorpion stings during the night as there is increased risk of accidental contact with the scorpion in the darkness. [14] In adults, most scorpion stings involve the extremities. [6],[12],[14],[15],[16],[17],[18]

In present study also most of the scorpion stings occurred at night and in the extremities. Scorpion venom is among the most potent of animal venoms. It affects the ion channels thus modifying their opening and closing mechanisms producing modifications of the transmembrane action potential or inducing changes in the sodium and potassium ion channel permeability. [19],[20],[21],[22] Scorpion venom is a water-soluble and antigenic complex mixture of toxins, including neurotoxin, cardiotoxin, nephrotoxin, hemolysins, phosphodiesterases, phospholipases, hyaluronidases, histamine, and serotonin. [4] These are responsible for the wide range of clinical manifestations, ranging from several local skin reactions to neurologic, respiratory, and cardiovascular complications seen in scorpion envenomation as illustrated to some extent in the current report. [23] Priapism and ventricular premature beats or nonsustained ventricular tachycardia may occur, though none was observed in the current study. [4],[11],[12],[24] In rare cases, there may be cardiogenic shock and pulmonary edema. [4],[11] Many nonspecific treatments including antihypertensive drugs and neuroleptic agents have been proposed in scorpion envenomation. [4],[11],[25] Most of the cases of mild envenoming can be managed with symptomatic measures. [4],[11] Although the scorpion antivenin is widely used in many countries; [4],[9],[26],[27] however, its role in the management scorpion sting is debatable. [7],[19],[28],[29],[30] In present study, majority of the patients could be managed with symptomatic and supportive measures. We did not use antivenin and steroids. It has been postulated that beneficial effects of steroids in scorpion envenomation include the modulation of inflammatory mediators and correction of acute adrenal insufficiency. [11] However, the clinical benefits of steroids in scorpion envenomation have not been widely evaluated. [11] The outcome of scorpion envenomation is good in the current report. Decline in scorpion related morbidity and mortality have been related to improved medical care. [31] Nonetheless, scorpion sting is associated with significant mortality in some parts of the world. [1],[25],[32],[33]


  Conclusion Top


Our data demonstrate that scorpion stings are more frequent in farmers with most stings occurring in the lower limbs during the daytime. Local pain was the most common manifestation. Scorpion stings could nonetheless be associated with severe complications with fatal outcome. Public awareness about preventive measures and early management of scorpion sting are recommended to reduce the incidence of scorpion sting and its related morbidity and mortality.

 
  References Top

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3.Soulaymani-Bencheikh R, Faraj Z, Semlali I, Khattabi A, Skalli S, Benkirane R, et al. Epidemiological aspects of scorpion stings in Morocco. Rev Epidemiol Sante Publique 2002;50:341-7.  Back to cited text no. 3
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