Antivenom for Critically Ill Children with Neurotoxicity from Scorpion Stings

Boyer, Leslie V.; Theodorou, Andreas; Berg, Robert A.; Mallie, Joanne; Chávez-Méndez, Ariana; García-Ubbelohde, Walter; Hardiman, S. T.; Alagón, Alejandro

doi:10.1056/nejmoa0808455

Cited by 161 publications

(91 citation statements)

References 14 publications

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“…Similarly, studies on children stung by Centruroides in Arizona have reported signifi cant improvement in the neurological picture, as well as a reduction of circulating venom compared to placebo (21) .…”

Section: Treatmentmentioning

confidence: 90%

“…Majority of the species of the Buthidae family induce similar reactions, except for Tityus obscurus in Brazil (18) (19) (20) , Centruroides (21) , and Parabuthus (22) , which also induce neurological manifestations. Signs and symptoms reported in envenoming caused by T. obscurus in some regions of Pará (Santarém) involve myoclonus (a sensation of an electric shock throughout the body), dysmetria, dysarthria, ataxia, paresthesias and hyperrefl exia, compatible with acute cerebellar syndrome with abnormal muscle movements, in addition to rhabdomyolysis and acute renal failure (19) (20) .…”

Section: Systemicmentioning

confidence: 99%

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Clinical update on scorpion envenoming

Cupo

2015

Rev. Soc. Bras. Med. Trop.

110

126

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Scorpion stings are currently the leading cause of venom-related injury to humans in Brazil and are a signifi cant public health problem globally. Only scorpions of the Tityus genus are of medical importance in Brazil, and Tityus serrulatus is responsible for the most serious envenomations and deaths. The toxic effects of scorpion envenomation are due to a massive release of sympathetic and parasympathetic neurotransmitters; the severity is related to cardiac and hemodynamic changes, with cardiogenic shock and pulmonary edema contributing to the main causes of death. The pathophysiology of cardiac involvement has been discussed for decades and has been attributed to adrenergic discharge and a possible toxic effect of venom on the myocardium, while acute pulmonary edema may have a cardiogenic and/or non-cardiogenic origin. Currently, the clinical data point to catecholamine excess as the cause for reversible scorpion cardiomyopathy. These data include electrocardiographic changes, profi ling of cardiac enzymes and troponin I, echocardiographic data with global or regional left ventricle dysfunction, and myocardial perfusion alterations compatible with spasm in the coronary microcirculation. Furthermore, recent data on cardiac magnetic resonance imaging fi ndings, which are similar to those observed for stress-induced cardiomyopathy, have also been linked to catecholamine excess. The effi ciency of antivenom serum treatment is controversial in the literature. Our experience in Brazil is that the management of patients with systemic manifestations of scorpion stings is based on three approaches, all of which are extremely important. These include symptomatic treatment, antivenom serum, and cardiorespiratory support.

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Section: Treatmentmentioning

confidence: 90%

Section: Systemicmentioning

confidence: 99%

Clinical update on scorpion envenoming

Cupo

2015

Rev. Soc. Bras. Med. Trop.

110

126

View full text Add to dashboard Cite

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“…Çocuklar-da akrep zehirlenmeleri erişkinlere göre daha ağır seyretmektedir. Antivenom karşıtı yayınlar olmasına rağmen ilk 1-4 saatte antivenom tedavisi ile kardiyak-sistemik bulguların önlenebildiğini gösteren yayınlarda vardır (21)(22)(23)(24)(25). Hastada antivenom tedavisine rağmen sistemik bulgular devam ediyor ise ilk tedaviden 1 saat sonra 2. doz antivenom tedavisi verilebilir (11).…”

Section: Bulgularunclassified

Çocuklarda akrep zehirlenmeleri ve yönetimi

Tolunay¹,

Tolunay²,

Bayram³

et al. 2014

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Amaç: Akrep zehirlenmesi tanısı ile Çocuk Yoğun Bakım Ünitemize yatan hastaları geriye dönük olarak inceleyerek hastaların klinik ve laboratuvar bulgularını, tedavi yöntemlerini ve sonuçlarını değerlendirmek. Gereç ve yöntem: Ocak 2012-Ekim 2013 tarihleri arasında Çocuk Yoğun Bakım ve Yoğun Bakım Servislerinde akrep zehirlenmesi tanısı ile tedavi edilmiş olan 30 hasta çalışmaya dahil edildi. Bu hastaların klinik ve laboratuvar bulguları, tedavi yöntemleri incelendi. Bulgular: Hastaların yaşları ortalama 6,6±4 yıl olup, 12' si (%40) kız, 18' i (%60) erkek idi. Tüm hastalara antivenom tedavisi uygulandı. 9 hastaya prazosin, 8 hastaya dopamin, 3 hastaya dopamin ve dobutamin tedavisi uygulandı. Vakaların 5'ünde kalp yetmezliği ve 2'sinde akciğer ödemi gelişti. Laboratuvar sonuçları; hemoglobin 11,8±1 g/dl (9,6-13,1), lökosit 10,5±3,1 bin/mm3 (6,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)6), trombosit 284±42 bin/mm3 (214-459), kan şekeri 135±50 mg/dL (60-105), kreatin kinaz miyokard izoenzimi (CK-MB) 40±22 U/L (<25), troponin 1,76±2,3 ng/mL (<0,04), B-tipi natriüretik peptid (BNP) 83±102 pg/ml (0-100) olarak saptandı. Ekokardiyografi (EKO) yapılabılan 7 hastadan 2'sinde (%6,6) EKO normal, 5 hastada da anormal (sol ventrikül disfonksiyonu, ejeksiyon fraksiyonu %40) olarak değerlendirildi. EKO sonuçları anormal olarak değerlendirilen 5 hastanın takibinde ejeksiyon fraksiyonları günler içinde normal sınırlara döndü. EKO sonucu anormal olan 2 hastada kalp yetmezliği ile beraber akciğer ödemi de gelişti. Akrep zehirlenmesi tanısı ile yoğun bakıma yatırılıp tedavi edilen 30 hasta sağlıklı olarak taburcu edildi. Sonuç: Akrep zehirlenmeleri ülkemizde halen önemli bir sorundur, uygun ve erken tedavi ile mortalite ve morbiditenin önüne geçmek mümkündür. Hastalarımız ve tedavi sonuçları göz önüne alındığında bölgemizde olan akrep sokmalarında uygun tedavi ile mortalite oranı düşüktür. Anahtar sözcükler: Akrep zehirlenmesi, çocuk, çocuk yoğun bakım Scorpion envenomation in children and managementObjectives: Retrospective examination of patients hospitalized to pediatric intensive care unit with scorpion envenomation and evaluation of clinical and laboratory findings of them, their treatment methods and results. Material and methods: Thirty patients treated with scorpion envenomation between January 2012 and October 2013 at pediatric intensive care and intensive care units were included in the study. Clinical and laboratory findings and treatments methods of these patients were examined. Results: Average age of patients was 6,6±4 years. Antivenom treatment was applied to all patients. Prazosin was applied to 9 patients, dopamine was applied to 8 patients and dopamine plus dobutamine treatment was applied to 3 patients. In 5 cases cardiac insufficiency and in 2 cases pulmonary oedema occurred. Laboratory results were as follows: haemoglobin 11,8±1 g/dl (9,6-13,1), leukocyte 10, 5±3,1x109L (6,3-12,6), thrombocyte 284±42x109L (214-459), glucose 135±50 mg/dL (60-105), creatine kinase-myocardial band 40±22 U/L (<25), troponine 1,76±2,3 ng/mL (<...

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“…Subsequent one-vial doses are recommended if symptoms do not resolve after a 30-60-min observation period [4]. A randomized, double-blinded placebo-controlled trial of 15 patients showed complete resolution of all 8 patients who received the antivenom within 4 h of administration versus 1 of 7 patients who received placebo [5]. Anascorp® use has been shown to be safe and effective and has allowed affected patients to be discharged from the emergency department with resolution of symptoms [6].…”

Section: Introductionmentioning

confidence: 99%