University of Utah University of Utah/Primary Children's Hospital Salt Lake City, Utah, USA
Introduction: Scorpion stings in children are more likely to cause severe illness as compared to adults. In the United States, Centruroides is most common genus of scorpion . The treatment for severe symptoms is Anascorp, a scorpion- specific antivenom.
Description: A two-year-old girl presented to the Emergency Department with inconsolable pain and rapidly progressive discoloration of her left digit. Upon examination, the patient displayed typical signs and symptoms of scorpion envenomation including localized pain, abnormal eye movements, drooling, extremity shaking and jerking, fasciculations, bronchoconstriction and tachycardia. Poison control was contacted, who recommended administration of three vials of Anascorp (scorpion antivenom). The patient subsequently developed worsening stridor, tachypnea and hypoxia. Ativan and racemic epinephrine were administered with improvement in symptoms and a fourth vial of Anascorp was given. She was admitted to the pediatrics floor where she again developed stridor that was treated with epinephrine, albuterol, and intravenous steroids. Poison control was re-consulted and felt that her signs and symptoms were no longer attributable to scorpion venom. Ultimately, she required intubation and persisted with severe bronchoconstriction and eventual hypotension that was attributed to anaphylaxis to Anascorp. Continuous epinephrine, Benadryl, ketamine infusion and continuous albuterol were started and she was transferred to the PICU. With treatment, she rapidly improved and was extubated after approximately 19 hours.
Discussion: Antivenom is created from serum- containing antibodies collected from animals injected with venom. The serum is often processed to decrease the amount of inactive proteins that may cause allergic reactions. Though serious adverse events from using antivenoms are rare, anaphylaxis is a major concern. Providers should be prepared to treat anaphylaxis prior to initiating antivenom therapies.
