title: Gastrointestinal manifestations in severe scorpion envenomation.
abstract: OBJECTIVE
  To evaluate the type and incidence of gastrointestinal manifestations secondary to scorpion envenomation and their prognostic significance.
  
  
  METHODS
  All patients admitted to our ICU for scorpion envenomation were included in this retrospective chart review of a 13-year period (1990 - 2002).
  
  
  RESULTS
  During the study period, 951 patients were admitted for scorpion envenomation and 72 (7.6%) died. Ages ranged from 0.5 to 90 years with a mean of 14.7 +/- 17.4 years. Gastrointestinal symptoms were present in 700 patients (73.6%): nausea in 24 (2.5%), vomiting in 687 (72.2%) and diarrhea in 41 patients (4.3%). At univariate analysis, the presence of diarrhea was associated with a fatal outcome (P < 0.05). Diarrhea was also correlated with other indicators of severe envenomation and poor prognosis: respiratory failure (P = 0.01), neurological failure (P < 0.0001), liver failure (P < 0.0001) and low blood pressure requiring catecholamine support (P = 0.02). The multivariate analysis showed that young age (age less than 5 years), fever > 38.5 degrees C, neurological failure and pulmonary edema were independent factors of severity. Digestive disorders were more frequent in children and in this subgroup diarrhea appeared to be associated with poor outcome. In a subset of patients for whom data were available, fatal cases demonstrated significantly higher liver enzymes levels on admission.
  
  
  CONCLUSIONS
  In Tunisia, gastrointestinal symptoms are often observed in severe scorpion envenomations, especially in young patients. In children, diarrhea and elevated liver enzymes are associated with poor prognosis.
authors.affiliation: Service de Réanimation Médicale, CHU Habib Bourguiba, Route El Ain, Km 1, 3029 Sfax, Tunisie. bahloulmab@yahoo.fr
authors.forename: Mabrouk
authors.initials: M
authors.lastname: Bahloul
authors.forename: Anis
authors.initials: A
authors.lastname: Chaari
authors.forename: Nadia
authors.initials: N
authors.lastname: Khlaf-Bouaziz
authors.forename: Leila
authors.initials: L
authors.lastname: Hergafi
authors.forename: Hichem
authors.initials: H
authors.lastname: Ksibi
authors.forename: Hatem
authors.initials: H
authors.lastname: Kallel
authors.forename: Adel
authors.initials: A
authors.lastname: Chaari
authors.forename: Hedi
authors.initials: H
authors.lastname: Chelly
authors.forename: Chokri
authors.initials: C
authors.lastname: Ben Hamida
authors.forename: Noureddine
authors.initials: N
authors.lastname: Rekik
authors.forename: Mounir
authors.initials: M
authors.lastname: Bouaziz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005767:Gastrointestinal Diseases / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D065008:Scorpion Stings / Q000150:complications*; D012605:Scorpions; D012720:Severity of Illness Index