Severe Cardiovascular Dysfunction and Pulmonary Edema in Children with Scorpion Envenomation

Scorpion envenomation is a life-threatening emergency and a common public health problem in children, especially during summer time in all regions of Turkey. Severe scorpion envenoming is characterized by cardiocirculatory failure which may lead to pulmonary edema. We aimed to evaluate clinical, laboratory, treatment and outcome characteristics for children with scorpion envenomation who required treatment in intensive care unit. Cardiovascular toxic effects and acute pulmonary edema are the most important complications and mortality factors for scorpion envenomation. We studied five patients (4-7 years), three girls and two boys. Four of the children were stung on foot, one on head. Three of them had respiratory distress, four had tachycardia and hypotension and three had lethargy. Three had pulmonary edema on chest X-ray. Four had high troponin values. Four had important echocardiographic evidence of moderate to severe systolic dysfunction. Two had serious cardiomyopathy. Intensive inotropic treatments were given to children with serious cardiomyopathy. Prazosin, diuretics and oxygen treatment were given to children suffering pulmonary edema. The clinical course for all patients was satisfactory and laboratory, electrocardiographic and echocardiographic changes returned to normal. Severe scorpion envenomation is characterized by myocardial damage, cardiovascular disturbances, lung edema and dysfunction of the autonomic nervous system. We decided that to analyse scorpion envenomation, systemic findings must be observed in intensive care unit to watch for the development of serious cardiomyopathy and pulmonary edema. Investigations may bring out the severity of a patient’s condition. A treatment plan should be determined according to the test results.