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Revista do Instituto de Medicina Tropical de São Paulo

On-line version ISSN 1678-9946

Rev. Inst. Med. trop. S. Paulo vol.37 no.4 São Paulo July/Aug. 1995

http://dx.doi.org/10.1590/S0036-46651995000400008 

ANIMAL ENVENOMATION

 

A comparative study of severe scorpion envenomation in children caused by Tityus bahiensis and Tityus serrulatus

 

Estudo comparativo do envenenamento escorpiônico grave em crianças provocado por Tityus bahiensis e Tityus serrulatus

 

 

Fábio BucaretchiI,II; Emílio CE. BaracatI,III; Roberto J.N. NogueiraI,IV; Aniel ChavesV; Flávio A.D. ZambroneII; Márcia R.C.C. FonsecaII; Francis S. TourinhoII

IDepartment of Pediatrics; Faculty of Medical Sciences, Campinas State University - UNICAMP, Campinas, SP, Brazil
IIPoison Control Center - Universitary Hospital - UNICAMP, Campinas, SP, Brazil
IIIPediatric Emergency Unit - Universitary Hospital - UNICAMP, Campinas, SP, Brazil
IVPediatric Intensive Care Unit - Universitary Hospital - UNICAMP, Campinas, SP, Brazil
VEchocardiography Unit - Universitary Hospital - UNICAMP, Campinas, Brazil

Correspondence to

 

 


SUMMARY

From January 1984 to May 1994, 17 of 239 children under 15 years old stung by Tityus serrulatus (15.1%) or Tityus bahiensis (84.9%) presented severe envenoming. Of these 17 patients (1-11 years old; median=2 yr) 14 were stung by T.serrulatus and three by T.bahiensis. All of them received scorpion antivenom i.v. at times ranging from 45 min. to 5 h after the accident (median=2h). On admission, the main clinical manifestations and laboratory and electrocardiographic changes were: vomiting (17), diaphoresis (15), tachycardia (14), prostration (10), tachypnea (8), arterial hypertension (7), arterial hypotension (5), tremors (5), hypothermia (4), hyperglycemia (17), leukocytosis (16/16), hypokalemia (13/17), increased CK-MB enzyme activity (>6% of the total CK, 11/12), hyperamylasemia (11/14), sinusal tachycardia (16/17) and a myocardial infarction-like pattern (11/17). Six patients stung by T.serrulatus had depressed left ventricular systolic function assessed by means of echocardiography. Of these, five presented pulmonary edema and four had shock. A child aged two-years old presented severe respiratory failure and died 65 h after being stung by T.serrulatus. Severe envenomations caused by T.serrulatus were 26.2 times more frequent than those caused by T.bahiensis (p<0.001).

Keywords: Scorpion envenomation; Tityus serrulatus, Tityus bahiensis.


RESUMO

No período de janeiro de 1984 a maio de 1994, de 239 crianças com até 15 anos de idade, picadas por escorpiões pertencentes às espécies T.bahiensis (84,9%) e T.serrulatus (15,1%), 17 apresentaram envenenamento grave. Destes 17 pacientes, cuja idade variou de 1 a 11 anos (mediana=2anos), 14 foram picados por T.serrulatus e 3 por T.bahiensis. Todos receberam anti-veneno escorpiônico i.v. entre 45 min. e 5 hs após o acidente (mediana=2 horas). À admissão, as principais manifestações clínicas, alterações laboratoriais e eletrocardiográficas observadas foram: vômitos(17), sudorese profusa(15), taquicardia(14), prostração(10), taquipnéia (8), hipertensão arterial(7), hipotensão arterial(5), tremores(5), hipotermia(4), hiperglicemia(17), leucocitose (16/16), hipocaliemia(13/17), aumento da CK-MB (>6% da CK total)(11/12), hiperamilasemia(11/14), taquicardia sinusal(16/17) e padrão semelhante ao infarto do miocárdio(11/17). A ecocardiografia, observou-se depressão da função sistólica ventricular esquerda em 6 pacientes, todos picados por T.serrulatus. Destes, 5 apresentaram edema pulmonar e 4 choque. Uma criança de 2 anos de idade, picada por T. serrulatus, faleceu 65 horas após o acidente devido insuficiência respiratória grave. Conclui-se que os acidentes graves determinados por T.serrulatus foram 26,2 vezes mais freqüentes que os determinados por T.bahiensis (p<0,001).


 

 

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ACKNOWLEDGEMENTS

We thank the medical and the nursing staff of the pediatric emergency and the intensive care units, of the Hospital das Clínicas, Universidade Estadual de Campinas (UNICAMP), for their dedication in the treatment of patients with scorpion envenomation. We also thank to Flavia S.F. Gellert and Stephen Hyslop for reviewing the English of the manuscript.

 

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Correspondence to:
Prof. Dr. Fábio Bucaretchi
Centro de Controle de Intoxicações, Hospital das Clínicas, 4º andar
UNICAMP, Cidade Universitária "Zeferino Vaz"
13081-970 Campinas, SP, Brasil
FAX - FONE 55-192-398670

Recebido para publicação em 02/01/1995
Aceito para publicação em 11/07/1995

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