Scorpion Sting management in pediatrics ICU

Scorpion bite

1. SCORPION STING DR. ALBAR SOOMRO RESIDENT PAEDIATRIC MEDICINE

2. OUTLINES Introduction Epidemiology Bio-ecological aspects Components of venom and mechanism of action Clinical course Investigations Treatment when anti-scorpion venom (ASV) is not available Prazosin and it’s adoptive measures Treatment when anti-scorpion venom (ASV) is available

3. INTRODUCTION

4. EPIDEMIOLOGY Scorpion stings are reported more from rural areas. Mostly stings occur between 6 P.M. to 12 A.M and 6 A.M. to 12 P.M. Scorpion sting occur more during summer than winter.

5. ECO-BIOLOGICAL ASPECTS

6. COMPONENTS OF VENOM AND MECHANISMS OF ACTION The components of venom are cardiotoxin, hemotoxin, nephrotoxin, neurotoxin, hyaluronidases, phosphodiesterases , phospholipases, glycosaminoglycans, histamine, serotonin, tryptophan and cytokine releasers. Most potent is the neurotoxin. There are two classes of neurotoxins Long chain polypeptide Short chain polypeptide

7. CLINICAL COURSE LOCAL EFFECTS AT THE SITE OF STING

8. NON-NEUROLOGICAL SIGNS

9. FIRST AID R = Reassure the patient I = Immobilization of the limb in the same way as a fractural limb GH = Get to Hospital Immediately. T =Tell the doctor all that happened from the time of scorpion sting

10. INVESTIGATIONS

11. TREATMENT Admission & Observation Hx for scorpion sting Quickly assess Airway, Breathing, Circulation Vitals Site of sting and the probable route of envenomation Chest expansion Clinically from head to foot as well as back Associated co-morbid illness[es] For consuming any medication[s]

12. TREATMENT 4. Administer Medications Meticulously Tetanus Toxoid Topical Anesthetic Inj. Lignocaine without adrenaline Oral Rehydration Solution (ORS) Tab. Paracetamol Tab. Prazosin

13. PRAZOSIN Alpha blocker 2-3 hours half-life and the action lasts 4-6 hours Peak concentration in plasma achieves in 1-3 hours Counteracts scorpion induced adrenergic cardiovascular effects and reduces pulmonary edema through vasodilator effect Started with small dose Recommended Dose: 30 mcg/kg Maximum Dose: 5 mg/day

14. ADOPTIVE MEASURES WITH PRAZOSIN Not be given as prophylactic dose Keep the patient in lying posture for about 3 hours Monitor pulse, BP, and respiration every 30 minutes for 3 hours then every 60 mins for 6 hours. Recheck the same every 4 hours till improvement is visible. Reassess for warmth and return of pain at the site of sting. Repeat Tab. Prazosin in the same dose at the end of 3 hours according to clinical response and later every 6 hours

15. MANAGEMENT OF SCORPION STING WHEN ANTI-SCORPION VENOM IS AVAILABLE

16. KEY MESSAGES Severe local pain at the site of sting is unlikely to progress to systemic manifestations. Autonomic storm is the basic pathogenic mechanism leading to all clinical features and complications of Scorpion sting. Traditional remedies have NO PROVEN benefit in treating scorpion sting Pulmonary edema is the most important manifestation. Warming up of extremities and appearance of local pain are suggestive of recovery. Addition of scorpion antivenom to prazosin enhances recovery time and shortens hospital stay of patients. Massive pulmonary edema needs sodium nitroprusside drip. Avoid using atropine, steroids, lytic cocktail, morphine.

17. THANK YOU Khadse S. Scorpion Sting. Journal of Pediatric Critical Care. 2016 Apr 1;3(2):42-8.