Objective: Scorpion envenomation is a common health hazard in the southern region of Israel. Cardiac dysfunction is the leading cause of morbidity and death. Early bedside echocardiography showed to identify all victims with cardiac involvement. We studied our management of stung children using clinical evaluation, serum troponin, and early echo examination in moderate to severe envenomation.
Design: Retrospective electronic medical records review of children admitted after scorpion sting during 5 years, 2008-2013.
Results: 185 children between 1 month and 18 years, 53 were younger than 3 years. Main clinical presentation included decrease level of consciousness (22%) and respiratory distress (14%). Echocardiography on arrival was performed on 117 (63%) and was abnormal in 29. All received inotropic support and 10 required mechanical ventilation. Serum troponin T was measured on arrival in 170 (92%) children and was elevated in 29, of whom 15 had abnormal echocardiogram. Comparing troponin results to echocardiography; it had a low sensitivity (52%) in identifying cardiac failure. 17 children younger than 3 years of age required ventilation for (central) hypopnea and apneic episodes, all had normal echo. All children survived the envenomation and discharged without sequel.
Conclusion: Early echocardiography should preferably be performed in all scorpion envenomated children. Early serum troponin misses sensitivity for cardiac dysfunction. Cardiac involvements are not common in children under age 3. Respiratory failure is not uncommon and is secondary to central CNS effect in young infants and cardiac dysfunction in older children.
