High-dose hydrocortisone hemisuccinate in scorpion envenomation.
OBJECTIVE
Scorpion envenomation is a common life-threatening hazard in tropical and subtropical countries. Standard treatment is not clearly defined. Many therapies, such as steroids, are prescribed without experimental justification. We sought to assess the efficacy of systematic administration of intravenous hydrocortisone hemisuccinate (50 mg/kg) in scorpion envenomation.


METHODS
Six hundred consecutive envenomated patients older than 10 years who presented to the ED of a nonteaching secondary hospital in an area of Tunisia endemic for scorpion envenomation were randomly assigned to receive hydrocortisone hemisuccinate 50 mg/kg (n = 305) or placebo (n = 295) in addition to standard medical care. Patients in the two groups had similar clinical characteristics on initial clinical evaluation. Each was categorized as grade 1 (absence of systemic symptoms) or grade 2 (systemic symptoms of scorpion envenomation). Patients were treated in the ED for up to 4 hours or in the ICU, depending on clinical severity. Steroid and placebo groups were compared according to mortality rate, change of severity grade 4 hours after presentation and treatment, and duration of hospital stay.


RESULTS
Distribution of patients with respect to severity grade was similar in the two groups at the 4-hour clinical evaluation. We detected no significant difference at the time of discharge between steroid-and placebo-treated patients with respect to mortality (one patient in each group) or duration of hospital stay. Extra costs incurred through steroid administration totaled US $989,000.


CONCLUSIONS
Our findings do not support the use of intravenous high-dose steroids in scorpion-envenomated patients. The discontinuation of this practice would reduce costs substantially.
Abroug
F
F
Intensive Care Unit, Centre Hospitalo-Universitaire Fattouma Bourguiba, Monastir, Tunisia.
Nouira
S
S
Haguiga
H
H
Elatrous
S
S
Belghith
M
M
Boujdaria
R
R
Touzi
N
N
Bouchoucha
S
S
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004311:Double-Blind Method; D004630:Emergencies; D019353:Endemic Diseases; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use; D007263:Infusions, Parenteral; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D065008:Scorpion Stings / Q000188:drug therapy* / Q000453:epidemiology; D012605:Scorpions; D017211:Treatment Failure; D014416:Tunisia / Q000453:epidemiology
D000893:Anti-Inflammatory Agents; C007133:hydrocortisone hemisuccinate; D006854:Hydrocortisone