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Abstract
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Scorpion sting is common in some global regions and mostly causes local envenoming of varying severity. Some estimates suggest that perhaps only 10% of those stung by even the most medically important species develop severe systemic envenomation; however, the frequency of severe envenomation is higher in children. With few exceptions, systemic envenomation by medically important species is characterized by relatively similar neurotoxic stimulation syndromes.
Here, we report a 12-y-old girl who developed toxic encephalopathy and lethal brain edema owing to scorpion envenomation (Leiurus abdullahbayrami [Scorpiones: Buthidae]). She was transferred to our pediatric intensive care unit from another center after 2 d of follow-up. Based on the documents provided by the other medical unit, the patient was intubated 1 to 2 h after the scorpion sting owing to confusion and respiratory distress and was given tetanus vaccine, 1 vial of antivenom (polyvalent antiscorpion antivenom, Refik Saydam Hygiene Center, Ankara, Turkey), and doxazosin therapy in the initial treating facility. Because the patient experienced cardiac arrest for 5 min, cardiopulmonary resuscitation was performed. When the ejection fraction of the left ventricle was 30% on echocardiography, she was referred to us with a diagnosis of toxic myocarditis.
Immediately after admission to our unit, she was intubated and had decompensated shock findings. Her Glasgow Coma Scale score was 6 of 15. Blood gas findings showed mild acidosis. Laboratory results showed white blood cell levels were 15.73×103·μL-1, hemoglobin was 11.9 g·dL-1, platelets was 254×103·μL-1, serum creatinine was 0.87 mg·dL-1, blood urea nitrogen was 24 mg·dL-1, aspartate aminotransferase was 244 U·L-1, alanine aminotransferase was 71 U·L-1, creatinine kinase was 8191 U·L-1, troponin T was 1924 pg·mL-1 (normal range: 0-14), N-terminal pro-brain natriuretic peptide was >35.000 ng·L-1, and CK-MB was 75 ng·mL-1 (normal range: 0-3.6); international normalized ratio was 1.59; activated thromboplastin time was 24.9 s; prothrombin time (PT) was 18.4 s; D-dimer was 3789 ng·mL-1 (normal range: 0-243); and fibrinogen was 5.58 g·L-1 (normal range: 2-3.93)...
Language: en |