Banner Good Samaritan Medical Center, 925 E. McDowell Road, 2nd Floor, Phoenix, AZ 85006, USA.
J Med Toxicol. 2012 Sep;8(3):258-62. doi: 10.1007/s13181-012-0233-3.
Bark scorpion envenomation is potentially life threatening in children and traditionally treated with antivenom (AV). We sought to describe the clinical course, management, complications and outcome of children with severe scorpion envenomation treated with supportive care during a period when AV was unavailable. A retrospective chart review was performed, all children presenting to a referral hospital between September 1, 2004 and July 31, 2006 with severe scorpion envenomation not receiving AV, were included. A standardized data abstraction form was used to record time of symptom onset, time to healthcare facility (HCF), clinical findings, treatment, complications, and length of stay. Eighty-eight patients were included with mean age of 3.7 years (0.33-12). Mean time to symptom onset was 20 min (0-130) and mean time to HCF was 79 min (10-240). Incidence of clinical manifestations include: neuromuscular agitation, 100 %; opsoclonus, 97 %; hypersalivation, 81 %; tachycardia, 82 %; hypertension, 49 %; vomiting, 38 %; fever, 28 %; respiratory distress, 33 %; and hypoxia, 18 %. Complications included rhabdomyolysis in 18 (20 %) and aspiration in 12 (13 %) patients. Intubation was required in 24 % of patients. The most frequently used agents to control symptoms were benzodiazepines (98 %) followed by opioids (69 %). Intravenous fluids were given to 84 %. Mean length of stay was 29 h (range, 6-73 h). There were no deaths. In addition to the classic findings of neuromuscular hyperactivity, opsoclonus, and hypersalivation, a high incidence of hyperadrenergic findings and respiratory compromise are noted in this series. A significant number of patients required mechanical ventilation. Benzodiazpines and opioids were the most common medications used to control symptoms.
棘皮动物蛰伤在儿童中可能有生命危险，传统上采用抗蛇毒血清（AV）治疗。我们旨在描述在抗蛇毒血清不可用时，采用支持性护理治疗的严重棘皮动物蛰伤儿童的临床过程、管理、并发症和结局。进行了回顾性图表审查，所有于 2004 年 9 月 1 日至 2006 年 7 月 31 日期间因严重棘皮动物蛰伤而未接受抗蛇毒血清治疗并就诊于转诊医院的儿童均被纳入研究。使用标准化数据提取表记录症状发作时间、就诊时间、临床发现、治疗、并发症和住院时间。共纳入 88 例患者，平均年龄为 3.7 岁（0.33-12 岁）。症状发作的平均时间为 20 分钟（0-130 分钟），就诊的平均时间为 79 分钟（10-240 分钟）。临床表现的发生率包括：神经肌肉兴奋 100%；眼球震颤 97%；流涎 81%；心动过速 82%；高血压 49%；呕吐 38%；发热 28%；呼吸窘迫 33%；和缺氧 18%。并发症包括横纹肌溶解 18 例（20%）和吸入 12 例（13%）。24%的患者需要插管。用于控制症状的最常用药物是苯二氮䓬类（98%），其次是阿片类药物（69%）。84%的患者给予静脉补液。平均住院时间为 29 小时（6-73 小时）。无死亡病例。除了神经肌肉兴奋、眼球震颤和流涎等经典表现外，本研究系列还发现了高发生率的高肾上腺素能表现和呼吸功能障碍。相当数量的患者需要机械通气。苯二氮䓬类和阿片类药物是最常用的控制症状的药物。
