Çocuklarda Akrep Zehirlenmeleri ve Yönetimi

Yıl 2014, Cilt: 24 Sayı: 1, 15 - 21, 01.01.2014

İlknur Tolunay Orkun Tolunay Yasin Bayram Tamer Çelik Ayla Kılıç Ümit Çelik

Öz

Amaç: Akrep zehirlenmesi tanısı ile Çocuk Yoğun Bakım Ünitemize yatan hastaları geriye dönük olarak inceleyerek hastaların klinik ve laboratuvar bulgularını, tedavi yöntemlerini ve sonuçlarını değerlendirmek. Gereç ve yöntem: Ocak 2012-Ekim 2013 tarihleri arasında Çocuk Yoğun Bakım ve Yoğun Bakım Servislerinde akrep zehirlenmesi tanısı ile tedavi edilmiş olan 30 hasta çalışmaya dahil edildi. Bu hastaların klinik ve laboratuvar bulguları, tedavi yöntemleri incelendi. Bulgular: Hastaların yaşları ortalama 6,6±4 yıl olup, 12’ si %40 kız, 18’ i %60 erkek idi. Tüm hastalara antivenom tedavisi uygulandı. 9 hastaya prazosin, 8 hastaya dopamin, 3 hastaya dopamin ve dobutamin tedavisi uygulandı. Vakaların 5’ünde kalp yetmezliği ve 2’sinde akciğer ödemi gelişti. Laboratuvar sonuçları; hemoglobin 11,8±1 g/dl 9,6-13,1 , lökosit 10,5±3,1 bin/mm3 6,3-12,6 , trombosit 284±42 bin/mm3 , kan şekeri 135±50 mg/dL , kreatin kinaz miyokard izoenzimi CK-MB 40±22 U/L

Anahtar Kelimeler

Akrep zehirlenmesi, çocuk, çocuk yoğun bakım

Scorpion envenomation in children and management

Öz

Objectives: Retrospective examination of patients hospitalized to pediatric intensive care unit with scorpion envenomation and evaluation of clinical and laboratory findings of them, their treatment methods and results. Material and methods: Thirty patients treated with scorpion envenomation between January 2012 and October 2013 at pediatric intensive care and intensive care units were included in the study. Clinical and laboratory findings and treatments methods of these patients were examined. Results: Average age of patients was 6,6±4 years. Antivenom treatment was applied to all patients. Prazosin was applied to 9 patients, dopamine was applied to 8 patients and dopamine plus dobutamine treatment was applied to 3 patients. In 5 cases cardiac insufficiency and in 2 cases pulmonary oedema occurred. Laboratory results were as follows: haemoglobin 11,8±1 g/dl 9,6-13,1 , leukocyte 10,5±3,1x109L 6,3- 12,6 , thrombocyte 284±42x109L , glucose 135±50 mg/dL , creatine kinase-myocardial band 40±22 U/L

Anahtar Kelimeler

Scorpion envenomation, child, pediatric intensive care

Kaynakça

• Özkan Ö. Akrep Antivenom üretimi. Turk Hij Den Biyol Derg 2008;65:97-108.
• Özkan Ö, Karaer Z. Akreplerin biyolojisi. Turk Hij Den Biyol Derg 2008;64:51-60.
• Özkan Ö, Karaer Z. Türkiye akrepleri. Turk Hij Den Biyol Derg 2003;60:55-62.
• Chippaux JP, Goyffon M. Epidemiology of scorpionism: a global appraisal. Acta Trop 2008;107:71-9.
• Bosnak M, Ece A, Yolbas I, et al. Scorpion sting envenomati- on in children in southeast Turkey. Wilderness Environ Med 2009;20:118-24.
• Altınkaynak S, Ertekin V, Alp H. Çocuklarda akrep zehirlenmele- ri. Türk Ped Arş 2002;37:48-54.
• Bahloul M, Chabchoub I, Chaari A, et al. Scorpion envenomation among children: clinical manifestations and outcome (analysis of 685 cases). Am J Trop Med Hyg 2010;83:1084-92.
• Bawaskar HS, Bawaskar PH. Scorpion sting: update. J Assoc Phy- sicians India 2012;60:46-55.
• Schroeder B. Envenomations. In: Kliegman R, ed. Nelson Textbo- ok of Pediatrics. 18th ed. Philadelphia: Saunders, 2011: 2460-65.
• Nhachi CF, Kasilo OM. Poisoning due to insect and scorpion stin- gs/bites. Hum Exp Toxicol 1993;12:123-5.
• Kumandaş S. Akrep sokması sonucu gelişen nadir bir komplikas- yon konvülziyon. Erciyes Tıp Derg 2008;30:175-179.
• T.C. Sağlık Bakanlığı birinci basamağa yönelik zehirlenmeler tanı ve tedavi rehberleri saha uygulaması çalışması 2006. Avaible at: http://kliniktoksikolojidernegi.org/wp-content/uploads/2013/02/ zehirlenmetani.pdf. (Accessed February 13,2014.)
• Deshpande SB, Alex AB. On the management of scorpion stings. Heart 2000;83:585-6.
• Bahloul M, Ben Hmida M, Belhoul W, et al. Hemolytic-uremic sy- ndrome secondary to scorpion envenomation (apropos of 2 cases). Nephrologie 2004;25:49-51.
• George Angus LD, Salzman S, Fritz K, et al. Chronic relapsing pancreatitis from a scorpion sting in Trinidad. Ann Trop Paediatr 1995;15:285-9.
• Bartholomew C. Acute scorpion pancreatitis in Trinidad. Br Med J 1970;1:666-8.
• Barthwal SP, Agarwal R, Khanna D, Dwivedi NC, Agarwal DK. Myocarditis and hemiplegia from scorpion bite--a case report. In- dian J Med Sci 1997;51:115-7.
• Chelliah T, Rajendran M, Daniel MK, Sahayam JL. Stroke fol- lowing scorpion sting. J Assoc Physicians India 1993;41:310.
• Bawaskar HS, Bawaskar PH. Efficacy and safety of scorpion anti- venom plus prazosin compared with prazosin alone for venomous scorpion (Mesobuthus tamulus) sting: randomised open label cli- nical trial. BMJ 2011;342:7136.
• Bawaskar HS, Bawaskar PH. Utility of scorpion antivenin vs pra- zosin in the management of severe Mesobuthus tamulus (Indian red scorpion) envenoming at rural setting. J Assoc Physicians In- dia 2007;55:14-21.
• Boyer LV, Theodorou AA, Berg RA, Mallie J, Chávez-Méndez A, García-Ubbelohde W. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med 2009;360:2090- 8.
• Foex B, Wallis L. Scorpion envenomation: does administration of antivenom alter outcome? Emerg Med J 2005;22: 195.
• Abroug F, Ouanes-Besbes L, Ouanes I, et al. Meta-analysis of cont- rolled studies on immunotherapy in severe scorpion envenomati- on. Emerg Med J 2011;28:963-9.
• Foex B, Wallis L. Scorpion envenomation: does antivenom reduce serum venom concentrations? Emerg Med J 2005;22:195–7.
• Deshpande SB. Antiscorpion venom scores over other strate- gies in the treatment of scorpion envenomation. J Postgrad Med 2010;56:253-4.
• Tamer AF, Bakırcı EM, Emre H. Toksik miyokardit ve akut kalp yetmezliğine sebep olmuş bir akrep sokması olgusu. ADÜ Tıp Fa- kültesi Dergisi 2011;12:41-3.
• Bahloul M, Chaari A, Ammar R, et al. Severe scorpion envenoma- tion among children: does hydrocortisone improve outcome? A case-control study. Trans R Soc Trop Med Hyg 2013;107:349-55.
• Karnad DR, Deo AM, Apte N, et al. Captopril for correcting diu- retic induced hypotension in pulmonary oedema after scorpion sting. BMJ 1989;298:1430-1.
• Bawaskar HS, Bawaskar PH. Management of the cardiovascular manifestations of poisoning by the Indian red scorpion (Mesobut- hus tamulus). Br Heart J 1992;68:478-80.
• Bawaskar HS, Bawaskar PH. Severe envenoming by the Indian red scorpion Mesobuthus tamulus: the use of prazosin therapy. QJM 1996;89:701-4.
• Bahloul M, Chaari A, Dammak H, et al. Pulmonary edema fol- lowing scorpion envenomation: mechanisms, clinical manifestati- ons, diagnosis and treatment. Int J Cardiol 2013;162:86-91.
• Natu VS, Kamerkar SB, Geeta K, et al. Efficacy of anti-scorpion venom serum over prazosin in the management of severe scorpion envenomation. J Postgrad Med 2010;56:275-80.
• Peker E, Oktar S, Dogan M, Kaya E, Duru M. Prazosin treatment in the management of scorpion envenomation. Hum Exp Toxicol 2010;29:231-3.
• Natu VS, Murthy RK, Deodhar KP. Efficacy of species specific an- ti-scorpion venom serum (AScVS) against severe, serious scorpi- on stings (Mesobuthus tamulus concanesis Pocock)-an experience from rural hospital in western Maharashtra. J Assoc Physicians India 2006;54:283-7.
• Sagarad SV, Thakur BS, Reddy SS, et al. NT-proBNP in Myo- carditis after a Scorpion Sting Envenomation. J Clin Diagn Res 2013;7:118–21.
• 36- Sagarad SV, Thakur BS, Reddy SS, et al. Elevated Cardiac Tro- ponin (cTnI) Levels Correlate with the Clinical and Echocardiog- raphic Evidences of Severe Myocarditis in Scorpion Sting Enveno- mation. J Clin Diagn Res 2012;6:1369–71.
• Sofer S, Zucker N, Bilenko N, et al. The importance of early bed- side echocardiography in children with scorpion envenomation. Toxicon 2013;68:1-8.
• Meki AR, Mohamed ZM, Mohey El-deen HM. Significance of as- sessment of serum cardiac troponin I and interleukin-8 in scorpi- on envenomed children. Toxicon. 2003;41:129-37.
• Akcan AB, Oygür N. Beyin Natriüretik Peptid ve pediatride kulla- nım alanları. Güncel Pediatri 2010;8:67-71.