The Intensive Care Management of Children with Scorpion Envenomation

Objective: Scorpion envenomation is a serious health problem worldwide, and a common health hazard in the southern region of Israel. Cardiac dysfunction is the leading cause of morbidity and death. Early bedside echocardiography showed to identify all victims with cardiac involvement. We looked for our management of stung children using clinical evaluation, serum troponin, and early echocardiography in cases of moderate and severe envenomation. Materials and methods: Retrospective cohort study of children admitted to the Pediatric Intensive Care Unit after scorpion sting during 5 years, 2008-2013. Review of electronic medical records for demography, clinical and laboratory data, especially echocardiography and serum troponin T level, treatment and outcome. Results: Total number of envenomated children was 185. Age ranged between 1 month and 18 years, 53 were below 3 years of age. Main clinical presentation included decrease level of consciousness (22%) and respiratory failure (15%). Echocardiography on arrival was performed on 117 (63%) children and was abnormal in 29, of whom 25 received inotropic support and 10 required mechanical ventilation. Serum troponin T was measured on arrival in 170 (92%) children and was elevated in 29, of whom 15 (52%) had abnormal echocardiogram; Comparing troponin results to echocardiography; it had a low sensitivity (52%) in identifying cardiac dysfunction. 17 infants below 3 years of age required ventilation for (central) hypopnea and apneic episodes. All children below age 3 had normal echocardiogram. All 185 children survived the envenomation and discharged without sequel. Conclusion: Early echocardiography should be preferably performed in all scorpion envenomated children. Early serum troponin misses sensitivity for cardiac dysfunction. In our patient population cardiac involvements was not present in children under age 3. Respiratory failure is mainly secondary to central CNS effect in young infants and cardiac dysfunction in older children.