A study on clinical features, complications and management of scorpion sting envenomation at a tertiary care hospital, in rural South India

Abstract

Background: Scorpion sting is a common medical emergency in rural India. Sparse published data are available regarding scorpion sting envenomation in adults from South India. Methods: We prospectively studied the clinical manifestations and two-dimensional echocardiography findings in fifty adult patients admitted with scorpion sting at a tertiary care teaching hospital in South India. Results: Their mean age was 34.8 ± 13.6 years; there were 28 (56%) males. Forty-one (82%) patients were stung over the limbs and the remaining over the rest of the body. Seventeen (34%) patients received prazosin within 5 h of sting; the remaining 33 (66%) received prazosin thereafter. Salient symptoms were pain over the sting area (n = 18, 36%), dyspnoea (n = 13, 26%), chest pain (n = 9, 18%), vomiting (n = 6, 12%), sweating (n = 5, 10%), nausea (n = 3, 6%), priapism (n = 7, 14%) and piloerection (n = 6, 12%). Common complications were accelerated hypertension (n = 12, 24%), pulmonary oedema (n = 10, 20%), myocarditis (n = 8, 16%), congestive heart failure (n = 6, 12%) and peripheral circulatory failure (n = 3.6%). Common electrocardiogram abnormalities were tachycardia (20%), T-wave inversion (10%), tall T-waves (10%), ST-depression (4%) and atrial fibrillation (2%). Mitral regurgitation was mild (Grade I) in 4 (8%) and moderate (Grade II) in 3 (6%) patients. Decline in left ventricular ejection fraction was noted (n = 14, 28%). Conclusion: Scorpion sting patients present with complaints of pain, palpitation, dyspnoea and paraesthesia. Complications such as hypertension, pulmonary oedema and sinus tachycardia are common. Early administration of prazosin is advocated for better outcome. Therefore, prudent knowledge on cardiovascular manifestations of the disease and timely management is pivotal for physicians.