¹III year Postgraduate, ²Assistant Professor, ³Professor and HOD, Department of General Medicine, Santhiram Medical College and General Hospital, Nandyal.

Email: suneast542@gmail.com

Table 1: Distribution based on Age

Pain at the site of sting(100%), Paresthesia(56%) ,Swelling (50%),profuse sweating(62%),Excessive salivation( 28%),Nausea andvomiting(22%) ,Cough(36%), dyspnea(32%) , palpitation(18%) ,Blurring of vision (12%),Pain abdomen (10%), altered sensorium (8%) among study group.

Table 3: Physical signs among the study group

Tachycardia was present in 39 patients (78%).Bradycardia was present in 4% of the patients. Tachypnea (34%), Hypertension( 26%), Hypotension(16%),Cold peripheries (38%), Piloerection (12%), Priapism (8%),Bronchoconstriction (8%). Encephalopathy (4%),right hemparesis(2%) present among study group. ECG changes were observed in 44(88%) of patients with Sinus tachycardia being the commonest finding; others include first degree AV block, prolonged PR interval, and ST-T changes. In the present study, 39 (78%) of patients had sinus tachycardia, and it is the commonest ECG change noted.Seven patients(14%)had ST-T changes. 3(6%) patients had a 1st degree AV block with prolonged PR. 3(6%) patients had QTc prolongation. One patient had SVT. 2D ECHO was normal in 92% of patients, while 8% of patients developed abnormalities like decreased LV EF, RWMA.

 22 % of patients developed pulmonary edema, which was evident on chest x-ray, while 78% of patients had a normal chest x-ray. Out of 50 patients, one patient died due to myocarditis and pulmonary edema, one patient developed hemiparesis and discharged with residual weakness, and the majority of patients (96%) recovered completely.

Table 4: Outcome of the study group

DISCUSSION

Scorpion sting is a common occurrence in this region and poses a considerable public health problem. It is an occupational, environmental hazard, more common from April to early June. When agricultural activities are high, and scorpions come out due to the sudden rise in temperature. Most of the scorpion sting inIndia is due toIndian red scorpion, and cardiovascular complications are most common. Myocarditis and pulmonary oedema are fatal complications that require urgent attention and ICU care for a few hours to days. Delay in recognition of pulmonary edema and hypoxemia increases morbidity and mortality. Illiteracy, ignorance, poverty, traditional faith healers trying treatment in remote areas lack transport and nonavailability of ventilation facilities in a nearby hospital and to delay inappropriate treatment. The use ofPrazosin has revolutionized the management of scorpion sting envenomation. Early and effective Prazosin therapy is the single most economical intervention for preventing complications. Since the role of scorpion antivenom inIndian red scorpion sting is controversial, Prazosin is an effective pharmacological and physiological antidote to venom. Irrespective of what specific drug is given, the majority of the patient requires good supportive care to alleviate the cardiovascular effects and limits the mortality. Kumaraswamy et al. found (2014)⁵ that swelling at the site was present in 45(42.5%) of the patients. Three patients had local cellulitis and gangrene. Altered sensorium was seen in 19 patients; three of them died, two presented with hypotension, and one with hypertension developed hypotension later. In ABDI study (2013)⁶regardingECG and ECHO findings in scorpion sting patients, the most common abnormality in ECG was PVC (13.9%) and others were including ST depression (9.3%), T-inversion (4.6%), AF (4.6%), U-wave (2.3%) and sinus arrhythmia (2.3%). There is no case of atrial-ventricular blocks. But studies have shown that there is no association between the severity and frequency of ECG changes. Early and effective prazosin therapy has reduced mortality. A study by H.S. Bawaskar and P.H. Bawaskar (1998)⁷ has shown that scorpion antivenom and Prazosin are equally beneficial in preventing complications, but Prazosin doesn't have an anaphylactic reaction, orally-administered, very cost-effective. The case fatality rate in the present study is 2%. Mortality in the study by Das S.⁸is6.2%, and Bawaskar H.S.⁹ is 6%.

CONCLUSION

These are the following findingsfrom this study;

1. The maximum number of cases were noted in younger individuals (15-30 years) in this accidental environmental hazard.
2. The male population is predominantly affected in this study, with a male to female ratio of 1.63: 1.
3. Most stings sustained during day time, in early hours when agricultural activities were highest.
4. Extremities were the most common body part stung, and there was no significant association between the site of sting and severity.
5. A significant delay in admission to hospital and administration of Prazosin was due to the fact that most of the time spent in taking conventional therapy in rural areas, traveling from remote regions.
6. Sting due to Mesobuthus species (red scorpion) was commonthan Palamneus species (Black scorpion).
7. Pain at the sting site was the most common presenting symptom, and tachycardia was the most common sign.
8. Hypertension was the common complication encountered.
9. Pulmonary oedema was the most severe complication encountered in a significant number of the patient requiring intensive monitoring.
10. The majority of the patients presented with grade II envenomation (38%), but patients with severe disease grade III and grade IV together constituted a significant proportion (40%). This is because of the referral pattern.
11. Altered sensorium was the most common CNS manifestation, with one patient developing focal neurological deficit.
12. Apart from sinus tachycardia, the most common ECG changes were ST-T wave changes.

REFERENCES

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