Some Biochemical Parameters as a Simple Tool for the Prediction of Severity of Scorpion Envenomation among Some Egyptian Children

BACKGROUND: Scorpion sting envenomation is a common public health problem in Egypt and life-threatening emergency, particularly in children. They are at greater risk of developing severe cardiac, respiratory, and neurological complications. Early evaluation of the severity of the envenomation is essential to institute adequate treatments and prevent mortality. AIM: The aim of this study was to assess the value of some routine biochemical parameters in the prediction of severity of scorpion envenomation among some Egyptian children. METHODS: A prospective observational study was conducted on all scorpion envenomated children, admitted to the poison control centre , Ain shams university hospitals from January to December 2015. On admission, all the children with envenomation were subjected to complete medical history, physical examination and routine biochemical laboratory tests. The patients were classified in to three main groups, according to the degree of severity; Group II (mild grade); Group III (moderate grade) and Group IV (severe grade). In addition, ten apparently healthy children were included as a control group (Group I). RESULTS: there were 25 patients (41.6%) in group II, 20 patients (33.4%) in group III and 15 patients (25%) in group IV. The mean age and body weight were significantly decreased in groups III and IV, being lower in group IV. The mean delay time between sting and hospital admission was significantly longer for group IV compared with group III followed by group II. The frequency of stings in lower limb (68%) was significantly higher than those on the upper limb (32%) in group II. It was significantly higher in upper limb than lower limb in groups III and IV. Clinically,the most common finding was severe pain at sting site in all studied groups. Furthermore, the results of patients in group IV were significantly higher when compared with group III as regards: the general manifestations (sweating, fever and cold extremities); respiratory manifestations (tachypnea, cyanosis and pulmonary edema); cardiac manifestations (hypertension, tachycardia and heart failure); neurological manifestations (agitation and coma) and gastrointestinal manifestations (vomiting and abdominal pain). The mean values of random glucose level, total WBC and platelet counts were significantly higher in groups III and IV when compared with control group, being higher in group IV when compared with group III. The mean values of CK-MB level were significantly higher in group IV when compared with control group. In severe cases (group IV), Platelet counts showed a significant positive correlation with WBC count, and CK-MB level values, In addition WBC count showed a significant positive correlation with CK-MB level. While glucose level showed insignificant correlation with CK-MB level, WBC and platelet counts. The mean duration of hospital stay was significantly longer in group IV compared with groups II and III. All the patients discharged with complete recovery with no morbidity or mortality. CONCLUSION: Increased levels of on admission glucose, CK-MB, total WBC and platelets count were more obvious in severely envenomated cases. Increased platelet, total WBC count and CK-MB level were found to be predictors of severe envenomation.