Osnaya-Romero N, Acosta-Saavedra L C, Goytia-Acevedo R, Lares-Asseff I, Basurto-Celaya G, Perez-Guille G, Possani L D, Calderón-Aranda E S
Instituto Nacional de Pediatría, Ciudad de México, Mexico; Hospital Del Niño Morelense, Cuernavaca, Morelos, Mexico.
Departamento de Toxicología, Centro de Investigación y Estudios Avanzados, IPN, Ciudad de México, Mexico.
Toxicon. 2016 Nov;122:103-108. doi: 10.1016/j.toxicon.2016.09.018. Epub 2016 Sep 29.
The scorpion Centruroides limpidus limpidus (C.l.l.) is endemic in México, producing hundreds of accidents in humans; children being one of the most susceptible targets. Few studies reported that severe envenoming by scorpion venom induces cardiac damage and electrolytes abnormalities in children, but the relationship of envenoming severity and toxic blood levels is unknown. The aim of this study was to determine the relationship among clinical status of envenoming, serum electrolyte, electrocardiographic abnormalities, and serum toxin levels in 44 children stung by scorpion over a period of 6 months in the State of Morelos, Mexico. The patients were said to be asymptomatic, when they presented just local symptoms, and were said to be symptomatic when showing local symptoms and at least one systemic symptom. The clinical status was evaluated at the admission at the emergency room of the Hospital, and 30 min after the administration of polyspecific F(ab')2 anti-scorpion therapy to symptomatic children. Forty-one percent of the children were asymptomatic and 59% symptomatic. Potassium and sodium imbalance and an elongation of the QT interval were detected; the rate of hypokalemia was higher in symptomatic than on asymptomatic children (50% and 6%, respectively). Hypokalemia persisted in 19% in symptomatic patients, whereas sodium reached normal levels 30 min after anti-venom therapy. The hypokalemia statistically correlated with elongation of the QT interval. The concentration of the toxic components of C.l.l in serum was significantly higher in symptomatic than asymptomatic children, and the serum levels of the toxic component significantly decreased to undetectable levels after the application of anti-venom therapy. Despite the small size of the sample, this study establishes that severity of envenoming was statistically related to potassium imbalance in serum, QT interval and the concentration of toxic components in serum, which decreased at undetectable levels after specific treatment with the anti-scorpion venom, correlating with clinical disappearance or greatly reduction of symptoms of envenomation.
墨西哥毒蝎（Centruroides limpidus limpidus，C.l.l.）在墨西哥为本土物种，导致数百起人类中毒事件；儿童是最易受影响的群体之一。少数研究报告称，蝎子毒液导致的严重中毒会使儿童出现心脏损伤和电解质异常，但中毒严重程度与血液中毒素水平之间的关系尚不清楚。本研究旨在确定墨西哥莫雷洛斯州44名在6个月内被蝎子蜇伤的儿童的中毒临床状况、血清电解质、心电图异常和血清毒素水平之间的关系。仅出现局部症状的患者被称为无症状，而出现局部症状且至少有一种全身症状的患者被称为有症状。在医院急诊室入院时对临床状况进行评估，并对有症状的儿童给予多特异性F(ab')2抗蝎毒治疗30分钟后再次评估。41%的儿童无症状，59%有症状。检测到钾和钠失衡以及QT间期延长；有症状儿童的低钾血症发生率高于无症状儿童（分别为50%和6%）。有症状患者中19%持续存在低钾血症，而抗蛇毒血清治疗30分钟后钠水平恢复正常。低钾血症与QT间期延长在统计学上相关。有症状儿童血清中C.l.l.有毒成分的浓度显著高于无症状儿童，应用抗蛇毒血清治疗后，有毒成分的血清水平显著降低至无法检测到的水平。尽管样本量较小，但本研究表明，中毒严重程度与血清钾失衡、QT间期以及血清有毒成分浓度在统计学上相关，经抗蝎毒血清特异性治疗后，这些指标降至无法检测到的水平，与中毒症状的临床消失或大幅减轻相关。
