Serum electrolyte changes in pediatric patients stung by scorpions. Osnaya-Romero N. I ; Basurto G. I ; Andrade S.
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Serum electrolyte changes in pediatric patients stung by scorpions. Osnaya-Romero N. I ; Basurto G. I ; Andrade S. I ; Figueroa J. I ; Carvajal Y. I ; Flores-Hernandez S. Correspondence to. Scorpion sting is a health problem in some places of Mexico.
The clinical manifestations of scorpion envenomation are variable and include metabolic alterations. Hyperkalemia is the most frequently reported metabolic alteration. The mean serum level of sodium was We found Key Words: serum electrolytes, scorpion stung children.
Scorpion stings currently represent an important public health problem. In , scorpion stings ranked 15 among the 20 most important recorded diseases in Mexico. The state of Morelos in Mexico has a high prevalence rate of scorpion sting cases 6. Certain factors are known to contribute to the severity of scorpion sting envenomation, among which are the patient's age and health status, as well as the involved scorpion species 4, 5. Scorpion venom acts on the sodium-potassium pump, producing from local symptoms to systemic problems which lead to changes in the victim's life.
Current studies on the toxins mechanisms of action have shown that they act on cell membranes producing changes on the trans-membrane action potential and permeability changes in calcium and potassium channels altering the release of neurotransmitters such as acetylcholine 2.
One of the main metabolic changes produced by scorpion stings is hyperkalemia. In Mexico, there is one report on hyperkalemia and hyponatremia in scorpion-stung children as part of the clinical manifestations. However, in HNM, we have reports of hypokalemia and hyponatremia. In the case of hyponatremia, we think this could explain abdominal distention caused by hypokalemic intestinal paralysis and hypernatremia, the cause of irritability and sleepiness manifested by our patients.
In view of this situation, we aimed at studying scorpion-stung children with a clinical record of not having received any treatment 24 hours after the sting 1, 3. Thus, a prospective, observational, descriptive and transversal study was carried out at the HNM Emergency Service where patients suspected of having been stung by a scorpion provided blood sample for the measurement of serum sodium, potassium and total calcium levels.
Blood samples were collected before the application of anti-scorpion serum. The patients were classified depending on the envenomation severity into mild, moderate and severe. This classification is based on Mexican Official Health Norms.
The administered treatment consisted of chlorpheniramine, 0. Patients with mild envenomation were observed for an hour. We only used descriptive statistics for this study. Eighty-two patients were included in the study, 49 The majority of the patients had symptoms related to scorpion envenomation. The patients' mean age was 60 months, ranging from 6 to months. Mean weight was 17kg range: 6. The mean time to onset of care after the scorpion sting was 40min minimum: 5min; maximum: min.
The average serum sodium level was The average potassium level was 3. Weight and age are factors that have been described as determining for the envenomation severity. However, our study did not show statistically significant results. Nonetheless, we did note that the group with the most severe symptoms was the youngest group of children. Patients with severe symptoms tended towards hypernatremia, whereas potassium levels were low, causing hypokalemia.
These electrolytic changes, both hypernatremia and hypokalemia, were seen to normalize only with the antivenom injection without the need of applying any specific treatment. It is worth mentioning that we observed metabolic activity of the ileum in Other observed alterations were diplopia, Calcium has always been a controversial topic for the treatment of scorpion sting envenomation. In our patients, serum calcium levels were within normal limits.
We suggest removing calcium from the current therapeutic scheme for treating scorpion stings. All alterations were absent after the treatment with antivenom. The onset time of care after a scorpion sting is an important factor in the degree of severity and the presence of complications.
We saw that patients treated earlier had less severe symptoms. The later patients were treated, the more severe their envenomation state. Therefore, patients treated later were clinically worse. This translates into a probable relationship between immediate medical care and the presence of severe envenomation. Further clinical studies should be conducted correlating serum electrolytes and electrocardiograms when the patient is admitted to verify whether hypokalemia is the cause of QT segment lengthening and cardiac changes described by other authors, and whether hypernatremia could be associated with the irritability seen in envenomed patients.
Clinical manifestations and management of scorpion envenomation. Public Health Rev. Cloning of genes encoding scorpion toxins: an interpretative review. Toxins Rev. Scorpionism and serotherapy in Mexico. Toxicon , , 32, Impacto social de las intoxicaciones causadas por animales ponzonosos. Anual Inst. Received: June 28, Accepted: July 7, Abstract published online: August 8, Full paper published online: March 8, Conflicts of interest: There is no conflict. All the contents of this journal, except where otherwise noted, is licensed under a Creative Commons Attribution License.
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2004, Number 4
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. Background: the scorpion puncture is a medical urgency. The greater frequency happens in Jalisco, Morelos and Guerrero.