Predictors of Myocardial Dysfunction in Children with Indian Red Scorpion (Mesobuthus tamulus) Sting Envenomation
Mesobuthus tamulus, the Indian red scorpion, is found in India, Pakistan, and Nepal, and its envenomation primarily targets the cardiovascular and pulmonary systems, resulting in myocardial dysfunction and pulmonary edema in severe cases. Prior studies have shown a decrease in pediatric mortality after scorpion envenomation with the administration of scorpion antivenom and prazosin; however, many victims still experience myocardial dysfunction. The goal of the current study was to identify risk factors for myocardial dysfunction in pediatric patients after Indian red scorpion envenomation to reduce overall morbidity.
The investigators conducted a prospective observational study at a tertiary care hospital in Southern India from 2012 to 2014. Inclusion criteria were patients younger than 13 years presenting with features consistent with scorpion sting envenomation. Myocardial dysfunction was defined as congestive cardiac failure, hemodynamic compromise, left ventricular dysfunction, elevated cardiac enzymes, and abnormal electrocardiogram. The study enrolled 85 children with an average age of 5.4 years. Overall, 28% of the patients experienced myocardial dysfunction, with significant predictive risk factors of hypotension at admission and increased time delay between envenomation and definitive treatment. Patients receiving antivenom and prazosin combination therapy had a decreased incidence of myocardial dysfunction when compared with patients receiving only prazosin.
The study emphasizes the importance of prompt referral and early and optimal treatment with scorpion antivenom and prazosin for pediatric patients presenting with high-grade Indian red scorpion envenomation to prevent myocardial dysfunction. Public health interventions include educating the public, referring facilities, and receiving facilities for prompt treatment after scorpion envenomation.
(Indian J Pediatr. 2015;52:297–301) A Kumar, S Krishnamurthy, R Srinivasaraghavan, et al.
Prepared by Matthew Stewart, MD, FAWM, University of Utah Emergency Medicine Global Health Fellow, Salt Lake City, UT, USA.