title: Outcome of scorpion sting envenomation after a protocol guided therapy.
abstract: OBJECTIVE
  Scorpion sting (SS) envenomation is a life threatening emergency in children, though not so severe in adults. Attempt to develop protocol using prazosin and dobutamine and few other drugs to treat SS.
  
  
  METHODS
  Children aged 0-13 years with a history of scorpion sting were studied. Clinical features, complications, drug therapy and outcome of the cases for the period 1992-97(N = 186) was collected by the authors and also from the medical records department (RETROSPECTIVE GROUP). Cases treated during 1997-2000 (N = 198) as per the protocol were recorded as PROSPECTIVE GROUP. All the cases were observed for at least for 24 hours. Cases coming within 4 hours of a sting were given a dose of Prazosin (30 mic.gm/Kg/dose) and were observed. Those who came after 4 hours & were asymptomatic received only symptomatic treatment. Cases with signs of envenomation received Prazosin every 6 hourly till recovery. Cases having acute pulmonary edema (APE) were treated with dobutamine and sodium nitroprusside drip. Complicated cases were monitored in PICU as per the protocol.
  
  
  RESULTS
  Complications associated with excessive parasympathetic and sympathetic stimulation were observed. Myocarditis was observed due to the toxin and excessive catecholamine, which complicated in left ventricular failure (LVF) and APE. Nearly half of the children with acute myocarditis developed APE. Death was mainly due to myocarditis and APE, with or without encephalopathy. Mortality was high in children who received steroid and antihistaminics outside and who came late (> 4 hours).
  
  
  CONCLUSIONS
  Complication rate remained almost same in both the groups. There was a significant reduction in overall mortality (P = < 0.0155) and in deaths associated with APE (P = < 0.0001) after the protocol guided therapy. There was also a reduction in mortality in encephalopathy group though not statistically significant. This treatment protocol and aggressive management of APE reduced the mortality due to SS significantly.
authors.affiliation: Department of Pediatrics and Cardiology, JIPMER, Pondicherry, India. nbiswal@jipmer.edu
authors.forename: Niranjan
authors.initials: N
authors.lastname: Biswal
authors.forename: Rani A
authors.initials: RA
authors.lastname: Bashir
authors.forename: Uday C
authors.initials: UC
authors.lastname: Murmu
authors.forename: Betsy
authors.initials: B
authors.lastname: Mathai
authors.forename: J
authors.initials: J
authors.lastname: Balachander
authors.forename: S
authors.initials: S
authors.lastname: Srinivasan
mesh_terms: D000293:Adolescent; D000818:Animals; D001733:Bites and Stings / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012604:Scorpion Venoms / Q000009:adverse effects; D012605:Scorpions; D016896:Treatment Outcome
chemical_list: D012604:Scorpion Venoms