Clinical Course of Bark Scorpion Envenomation Managed Without Antivenom

Abstract

Bark scorpion envenomation is potentially life threatening in children and traditionally treated with antivenom (AV). We sought to describe the clinical course, management, complications and outcome of children with severe scorpion envenomation treated with supportive care during a period when AV was unavailable. A retrospective chart review was performed, all children presenting to a referral hospital between September 1, 2004 and July 31, 2006 with severe scorpion envenomation not receiving AV, were included. A standardized data abstraction form was used to record time of symptom onset, time to healthcare facility (HCF), clinical findings, treatment, complications, and length of stay. Eighty-eight patients were included with mean age of 3.7 years (0.33-12). Mean time to symptom onset was 20 min (0-130) and mean time to HCF was 79 min (10-240). Incidence of clinical manifestations include: neuromuscular agitation, 100 %; opsoclonus, 97 %; hypersalivation, 81 %; tachycardia, 82 %; hypertension, 49 %; vomiting, 38 %; fever, 28 %; respiratory distress, 33 %; and hypoxia, 18 %. Complications included rhabdomyolysis in 18 (20 %) and aspiration in 12 (13 %) patients. Intubation was required in 24 % of patients. The most frequently used agents to control symptoms were benzodiazepines (98 %) followed by opioids (69 %). Intravenous fluids were given to 84 %. Mean length of stay was 29 h (range, 6-73 h). There were no deaths. In addition to the classic findings of neuromuscular hyperactivity, opsoclonus, and hypersalivation, a high incidence of hyperadrenergic findings and respiratory compromise are noted in this series.A significant number of patients required mechanical ventilation. Benzodiazpines and opioids were the most common medications used to control symptoms.

Nationwide Scorpion Exposures Reported to US Poison Control Centers from 2005 to 2015

“…Children under 10 years of age had the highest frequencies of major effects, as well as vomiting, a finding which has been reported previously [25]. This age group also had the highest frequency of hospitalization and ICU admission.…”

Clinical Presentation and Outcomes Associated with Different Treatment Modalities for Pediatric Bark Scorpion Envenomation

“…Children in this group were older and only 3 % had respiratory distress. The mean ED LOS of 261 min in this group, while similar to the other treatment groups in this study, differs greatly from the LOS of 28.7 h that was reported in a previous pediatric scorpion envenomation cohort presenting to PCH when antivenom was unavailable [7]. This comparison highlights the relative mild severity of illness of children in group 1.…”

“…Common pharmacologic treatment includes benzodiazepine and opioid administration to control agitation and pain [7,8]. With only supportive care, patients often require admission to the ICU and mechanical ventilation [7].…”

A Case of Acute Myocarditis and Rhabdomyolysis after a Scorpion Sting

“…The classical triad contains myalgia, generalized weakness, and dark colored urine. Conner reported that rhabdomyolysis developed in 20% of cases after scorpion envenomation (10). Levels of CK were seen above 1000 IU/L in patients that developed rhabdomyolysis in the same study.…”