Severe Scorpion Envenomations in Pediatric Intensive Care Unit

• Published in: Medical journal of Bakirköy Vol. 18; no. 1; pp. 101 - 107
• Main Authors: Kıhtır, Hasan Serdar, Özdemir, Gökmen, Kocabaş, Abdullah, Bayram, Yasin, Ongun, Ebru Atike
• Format: Journal Article
• Language: English
• Published: Galenos Yayınevi 01-03-2022
• Subjects: Tıp; İstanbul; Türkiye; Scorpion stings; Akrep sokmaları; hyperamylasemia; pediatrik; yoğun bakım ünitesi; hiperamilazemi; intensive care units; pediatric
• ISSN: 1305-9319; 1305-9327
• DOI: 10.4274/BMJ.galenos.2022.2022.2-1

Objective: This study aimed to determine the general characteristics and warning signs for the more severe (grade 3) clinical course in severe
scorpion envenomations in the pediatric intensive care unit (PICU).
Methods: This retrospective, cross-sectional study was conducted in 12 beds tertiary care PICU in Antalya Training and Research Hospital.
Patients admitted to the PICU between 2017-2021 due to severe scorpion envenomation were admitted to the study.
Results: It was found that there were 2,208 admissions to the intensive care unit during the study period (4 years), and 73 (3.3%) of these cases
(35 female and 38 male) were followed up for severe scorpion envenomation. The median age was 52 (26-89) months. Yellow scorpions were
described by parents or eyewitnesses in 65 patients (89%) and black scorpions in 8 (11%). Peripheral sympathetic activity (cold extremities,
diaphoresis) signs (n=55, 75.3%), hypertension (n=35, 47.9%), and tachycardia (n=21, 28%) were the most common findings. The most common
echocardiographic findings were mild-to-moderate mitral regurgitation and systolic dysfunction in 31 (42.5%) and 19 (25.9%) cases, respectively.
Sixty-two (89%) patients had grade 2 envenomations findings and 12 (11%) had grade 3. High pro-BNP, hyperglycemia, and hyperamylasemia
were observed more frequently in grade 3 than in grade 2 patients on admission. All patients received anti-venom therapy and 7 (9.5%) of them
required a second dose of anti-venom therapy due to the unregressed clinical course. Twenty-seven patients (37%) required inotropics, s and
the most commonly used inotropics were milrinone in 17 (23.3%) patients and dobutamine in 12 (16.4%) patients. The median PICU length of
stay was 4 (3-5) days and the median hospital stay was 5 (4-6) days. All patients survived to discharge.
Conclusion: Hyperamilasemia, hyperglycemia, and elevated pro-BNP levels on admission may be warning signs of more severe (grade 3)
patients. Mild-to-moderate mitral regurgitation may be more commonly observed echocardiography findings than systolic dysfunction in severe
cases (grade 2 and 3).