title: Hyperglycemia is a risk factor for high-grade envenomations after European viper bites (Vipera spp.) in children.
abstract: BACKGROUND
  Hyperglycemia has been described in severe scorpion envenomation, we wanted to analyze if it was applicable to viper bites in children.
  
  
  OBJECTIVE
  To describe clinical, biological, and therapeutic characteristics of 83 children bitten by European viper (Vipera spp.) and to confirm that hyperglycemia is a risk factor for high-grade envenomation.
  
  
  METHODS
  A retrospective study was conducted between 2001 and 2014 in the pediatric emergency department of a tertiary level children's hospital. Collected data were: age and sex of children; day and time of admission; day, time and circumstances of the accident; snake identification; bite location; envenomation severity; presence of fang marks; prehospital care; laboratory abnormalities, use of specific immunotherapy, associated treatments; length of stay; hospital course.
  
  
  RESULTS
  Eighty-three children were included (62 boys, 21 girls). The mean age was 7.4 ± 3.9 years. Bites were most often located on the lower extremities (66%). The classification of envenomation was: 83% low grade (absent or minor envenomation) and 17% high grade (moderate to severe envenomation). All high-grade envenomations received specific immunotherapy (Viperfav(TM), (Aventis Pasteur, MSD, Lyon, France). Being bitten on an upper extremity (odds ratio [OR] 51.1 95% class interval [CI] [6.1-424], p < 0.0001), during the afternoon (OR 13.4 95% CI [1.7-107.9], p = 0.015), feeling violent pain (OR 4.2 95% CI [1.1-16.5], p = 0.023), and high initial plasma glucose level (6.5 ± 1.7 mmol/L versus 5.0 ± 0.9 mmol/L, p = 0.027) were associated with a significant risk of high-grade envenomation.
  
  
  CONCLUSIONS
  We have confirmed a potential link between initial hyperglycemia and the risk of progression to high-grade envenomation as well as its association with other published predictive factors.
authors.affiliation: a Pediatric Emergency Department , Children Hospital , Toulouse , France ;
authors.forename: I
authors.initials: I
authors.lastname: Claudet
authors.affiliation: a Pediatric Emergency Department , Children Hospital , Toulouse , France ;
authors.forename: E
authors.initials: E
authors.lastname: Grouteau
authors.affiliation: b Regional Poison Centre, CHU Purpan , Toulouse , France.
authors.forename: L
authors.initials: L
authors.lastname: Cordier
authors.affiliation: b Regional Poison Centre, CHU Purpan , Toulouse , France.
authors.forename: N
authors.initials: N
authors.lastname: Franchitto
authors.affiliation: a Pediatric Emergency Department , Children Hospital , Toulouse , France ;
authors.forename: C
authors.initials: C
authors.lastname: Bréhin
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000818:Animals; D000997:Antivenins / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000150:complications* / Q000175:diagnosis; D007223:Infant; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D012909:Snake Bites / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D014757:Viper Venoms; D017819:Viperidae
chemical_list: D000997:Antivenins; D015415:Biomarkers; D001786:Blood Glucose; D014757:Viper Venoms
keywords: Viper bite; envenomation; high grade; hyperglycemia; pediatric