Krutika Anand Morappanavar1 , Pritesh Masih2 , Kadappa Chanabasappa Jaligidad3 , S. M. Goornavar4
BACKGROUND Scorpion sting is a public health hazard in tropical and subtropical countries. Our objective was to study the clinical manifestations, various electrocardiographic features and outcome of scorpion sting envenomation. We also intended to identify prognostic factors that could aid in preventing fatal outcomes in scorpion envenomation. METHODS A retrospective analysis of 156 patients of scorpion sting envenomation aged above 15 years admitted at our hospital between January 2015 and December 2019 was done. Based on signs and symptoms, patients were classified into three classes of the ADELF congress consensus classification.3,11 RESULTS Scorpion envenomation accounted for 7.26 % (156) of all admissions with a case fatality rate of 1.92. Majority of the patients presented to the hospital between 1 - 4 hours of the sting (46.8 %). As the duration between the sting and arrival to the hospital increased, a higher proportion of patients were classified into class 3. All the patients reported pain at the local site of sting (100 %). Life threatening signs like pulmonary oedema (7.7 %) and myocarditis (7.7 %) were infrequent. Majority of the patients had normal sinus rhythm (56.4 %). Sinus tachycardia was found in 24.4 % patients followed by T wave changes in 10.3 % patients. Mortality was significantly higher in severe envenomation (p value 0.004). Prazosin therapy was noted to be significantly effective as compared to symptomatic management alone (p value 0.04). CONCLUSION Pain was noted to be sine-qua-non for the diagnosis of scorpion envenomation in our study. Majority of the patients had one or the other autonomic findings, most common being tachycardia and profuse sweating. Sinus tachycardia and T wave inversion were common ECG findings. All patients responded well to prazosin therapy. Although sinus tachycardia was a non-specific sign, its persistence for more than 24 hours could herald an autonomic storm with features of myocarditis and pulmonary oedema as seen in our study. We propose the use of persistent tachycardia as a prognostic marker to aid intensive care management in anticipation of an impending autonomic storm.
