Transactions of the Royal Society of Tropical Medicine and Hygiene

Abstract

This paired case-control study examined the safety and efficacy of using hydrocortisone in children with severe scorpion envenomation requiring the intensive care unit (ICU). The study took place in Tunisia, which has an estimated 40,000 scorpion stings per year, with the most severe envenomations caused by the species Androctonus australis and Butus occitanus. The clinical symptoms and signs of scorpion envenomations are caused by massive catecholamine release, direct venom effects, and generalized inflammation. The authors postulate that steroids may reduce the proinflammatory effect of massive cytokine release after scorpion envenomation; however, this is the first study to directly investigate steroid use for scorpion envenomation in children. The investigators reviewed ICU records for a 13-year period and matched patients receiving steroids with control patients who did not receive steroids by age, severity factors, and scorpion antivenom administration. Primary outcome measures were ICU mortality rate, use of mechanical ventilation, duration of ICU stay, and laboratory analysis. A total of 685 children were admitted for scorpion stings, and 92 received steroids with hydrocortisone hemisuccinate (200–300 mg per 24 hours for 48 hours). The 2 groups had the following similar characteristics: 50% received the scorpion antivenom, 79% developed pulmonary edema or cardiogenic shock, and 66% required catecholamines for hemodynamic support. There was no significant difference in mortality rate (8%), the use of mechanical ventilation (35%), or duration of ICU stay (average 2.6 days) between the 2 groups. The steroid group had a higher rate of hyperglycemia and hypokalemia; however, there were no other significant laboratory differences. The investigators concluded that the prognosis of children with severe scorpion envenomation admitted to the ICU was not improved by the use of hydrocortisone. Limitations of the study include that is was a single-site investigation and potential changes in clinical management during the study period. (Trans R Soc Trop Med Hyg. 2013;107:349–355) M Bahloul, A Chaari, R Ammar, et al.