This is my first attempt to post the papers from our monthly wilderness medicine meetings so please bear with me. Last month Dr. Grock reviewed a nice paper discussing the dangers of messing around with the yellow scorpion. Lucky for us, you won’t find them in this part of the world. Here is his paper:
We discussed this paper and had a few nice frosty beverages. In the end, Dr. Grock also wrote a nice summary of the paper. If you don’t want to read the entire paper, here is what he found:
Lethal Brain Edema, Shock, and Coagulopathy After Scorpion Envenomation
Yuval Cavari, MD: Isaac Lazar, MD; Ilan Shelef, MD; Shaul Sofer, MD
Summary: 2 yr old bedouin boy developed multi-system organ failure – seizure then coma with brain edema, noncardiogenic shock, DIC, renal failure, hepatic failure, and diarrhea – after likely sting from yellow scorpion.
Usual severe symptoms of scorpion sting are sympathetic and parasympthatic nervous system stimulation or depression with priapism pathognomonic for scorpion sting. Known specific symptoms are heart failure, pulmonary edema, and cardiogenic shock.
This case involved 2 yr found with AMS/diaphoresis in area known to have yellow scorpions. No trauma/presumed or other ingestions.
On arrival had AMS, increased muscle tone, diaphoresis, priapism. VS sig for tachycardia, hyperthemic, mild hyperthermia
Started on D5 1/3 maintenance, midazolam, fentanyl. Nml echo. Nml labs.
4 hour hours after arrival, had tonic/clonic seizure which resolved with 1 mg diazepam.
The pt then decompensated – shock with CV collapse. IV NS bollus, FFP, intubation, anti-venom serotherapy given, CVL placed.
Dopa/dobutamine /adrenaline/ceftriaxone/phenytoin loading dose given with persistent hypotensive x 6 hours.
Labs showed DIC, drop in Hgb (blood tx given).
Pt developed ARF/acidosis with elevated Na and watery diarrhea.
Liver enzymes bumped.
Echo remains nml
CT head shows brain edema with ischemic changes – transtentorial herniation. Mannitol/mild hyperventilation started without success. Pt declared brain dead.
Discussion: Most likely dx scorpion sting (per authors) as echo nml, blood cx’s neg, “no documented” hypoxia. CNS injury has happened due to severe hyperthermia. Possibly, children are more susceptible for venom to cross blood-brain barrier. Hx of cases of CNS problems in young children after sting, but no documented CT.
Limitations: no documented sting – based on constellation of symptoms. Pesticide exposure r/out by labs. Possibly resp failure before coming to ED leading to multi-organ system failure – but VS not severely deranged on arrival.
silverfish8
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