Emergency (****); * (*): *-* This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2013 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com 24 Emergency (2013); 1 (1): 24-26 BRIEF REPORT Report of 267 Cases of Scorpion Bite Referring to an Emergency Department during One Year Mohammad Manouchehrifar1*, Shaghayegh Khosravi2, Ali Khavanin2, Niloufar Derakhshandeh2 1. Department of Emergency Medicine, Haftome Tir Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran 2. Department of Emergency Medicine, Golestan Hospital, Ahwaz University of Medical Sciences, Ahwaz, Iran Abstract Scorpion bite is a common health problem in many parts of the world, including the Iran’s tropics. There are thousands of cases and a number of deaths due to scorpion bite every year in the country. The present study aims to provide further data regarding the details, complications and outcomes of scorpion bite cases referring to Razi Hospital, Ahwaz, from March 2011 to April 2012. 267 patients (56.3% females) with a mean age of 35.2±15.8 years were included in the study. The most common genus of scorpion involved was Hemiscorpius (69.3%) and the most frequent body part involved was the lower limb (38.9%). The fre- quency of hemolysis-induced renal insufficiency and death after scorpion bite were 1.9% and 1.1%, respec- tively. Of all the factors evaluated in this series only the old age was associated with higher possibility of renal insufficiency (P<0.001). Key words: Bites and stings; scorpion, hemolysis; environmental; poisoning Cite this article as: Manouchehrifar M, Khosravi Sh, Khavanin A, Derakhshandeh N. Report of 267 cases of scorpion bite referring to an emergency department during one year. Emergency. 2013;1(1):24-6. Introduction:1 corpion bite is a common health problem all over the world, including the Iran’s tropics (1, 2). In Iran, Khouzistan and Hormozgan Prov- inces are regions with a lot of scorpions and there are thousands of reports each year about scorpion bite with a number of related deaths (3). In rural areas of Khouzistan scorpion envenomation is the fourth common cause of death (4). The scorpions in Iran belong to three families, 18 genera, 29 species and 5 subspecies (5). One study in Khouzistan re- ported Mesobuthus, Androctonus, and Hemiscorpius are responsible for 89.1% of bites (6). Of all these families Scorpionidae and Buthidae are the most important ones; in this context, Hemiscorpius is re- sponsible for 95% of deaths and Androctonus Cras- sicauda (black scorpion) is the most dangerous type (7, 8). Considering what discussed above, it is neces- sary to increase the knowledge of the health and treatment system about the details of scorpion bite, complications and outcomes of patients in these re- gions. Therefore, the present study aimed to report *Corresponding Author: Mohammad Manouchehrifar; Department of Emergency Medicine, Haftome Tir Hospital, Shahre Rey, Iran, 1617763141 Mobile phone: +989144145867; phone: +982188987705. Email: arashmanouchehrifar@yahoo.com Received: 15 October 2013; Accepted: 15 November 2013 the characteristics of scorpion bite in patients refer- ring to the emergency unit of a hospital in Ahwaz city. Methods: The present case series has evaluated the victims of scorpion bite, who had been hospitalized in Razi Hospital, Ahwaz city, from March 2011 to April S Table 1: Details of scorpion bite victims  Particulars Number (%) Location of incident City 196 (73.5%) Village 71 (26.5%) Scorpion family Hemiscorpius lepturus 185 (69.3%) Androctonus crassicauda 26 (9.7%) Mesobuthus eupeus 3 (1.1%) Not known 53 (19.9%) The body part involved Head and neck 31 (12.1%) Trunk 33 (12.8%) Abdomen 1 (0.4%) Upper limb 88 (34.2%) Lower limb 100 (38.9%) Multiple 4 (1.6%) mailto:arashmanouchehrifar@yahoo.com This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2013 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com 25 Manouchehrifar et al. 2012. Data collected from the patients files, retro- spectively, consisted of age, gender, location of the incident, the body part involved, the type of the scorpion involved, duration of hospitalization, clini- cal symptoms and signs, laboratory findings, type of the treatment rendered and patients’ status at dis- charge. Data was registered in the database designed to this end and analyzed with SPSS 18. After provid- ing a descriptive analysis, to examine the relation- ship between variables chi-square test was used. P value < 0.05 was considered as significant. Patients: During the period of study, 267 patients (56.3% fe- males) were referred to the emergency unit due to scorpion bite. The mean age of the patients was 35.2±15.8 years (range: 14-86). Table 1 presents details about the incidents. The most common type of scorpion involved was Hemiscorpius (69.3%). 188 (73.1%) bites had occurred in limbs (lower limb, 38.9% and upper limb, 34.2%) and only four (1.6%) patients had been received multiple bites in the limbs and trunk. The patients had been hospital- ized for a mean period of 3.0±1.5 days (range: 1-11). 22 patients had been hospitalized to the intensive care unit (ICU) for a mean period of 4.3±2.2 days. 76 (28.4%) patients simultaneously had a positive uri- nary test tape and a urinary RBC≤ 5/mm2, as an in- dicator of hemoglobinuria. Finally, five (1.9%) pa- tients had suffered from hemolysis-induced acute renal insufficiency during the hospitalization period and three (1.1%) of them had required dialysis (Tables 2 and 3). No significant relationship was found between the type of involved scorpion and the chances of hemolysis and incidence of hemoglobinu- ria and renal insufficiency (P>0.05). In addition, of the factors of age, gender, the body part involved, anemia and leukocytosis, only age had a significant relationship with renal insufficiency (P<0.001). Finally, eight patients had required injection of blood products after hemodialysis. All the patients Table 2: Demographic data of patients with acute renal insufficiency  Variables Cases 1 2 3 4 5 Sex Female Female Male Female Male Age 28 19 30 79 86 Location City City City Village Village Involved body part Upper limb Lower limb Trunk Lower limb Head and neck Scorpion family Hemiscorpius Not known Hemiscorpius Androctonus Hemiscorpius hospitalization (days) 7 1 6 5 4 ICU1 (days) 5 1 6 5 4 Need for dialysis + - - + + Need for blood + - - - - Anti-venom + + + + + Outcome Death Discharge Discharge Death Death 1 Intensive care unit Table 3: Details of laboratory results of patients with acute renal insufficiency  Laboratory Tests Cases 1 2 3 4 5 Urine protein (mg/dl) 3 0 0 0 1 Urinary WBC1 (1 /mm3) 10 2 12 42 60 Urinary RBC2 (1/mm3) 6 2 4 12 8 Hematuria 4+ 1+ 1+ 3+ 3+ Creatinine (mg/dl) 3.1 1.7 1.7 2.3 1.8 BUN3 (mg/dl) 164 19 17 28 16 Platelet (×1000) 103 203 169 105 98 PTT4 (/second) 37 31 43 52 58 PT5 (/second) 18 12 12 17 17 WBC (/mm3) 24.3 14.9 5.2 17.8 19.1 Hemoglobin (mg/dl) 7.9 8.2 11.6 9.8 9.2 1 White blood cell; 2 Red blood cell; 3 Blood urea nitrogen; 4 Partial thromboplastin time; 5 Prothrombin time This open-access article distributed under the terms of the Creative Commons Attribution NonCommercial 3.0 License (CC BY-NC 3.0). Copyright © 2013 Shahid Beheshti University of Medical Sciences. All rights reserved. Downloaded from: www.jemerg.com 26 Emergency (2013); 1 (1): 24-26 had received anti-venom and 50.7% antibiotics and 43.6% corticosteroids. Finally, 245 patients (91.8%) had been discharged without any specific complica- tions and three (1.1%) died. 19 (7.1%) patients had left the hospital against medical advice before com- pletion of diagnostic and therapeutic procedures. Discussion: The most common type of scorpion in these series was Hemiscorpius and the most common body part was the lower limb. The frequency of renal insuffi- ciency and mortality due to the scorpion bites were 1.9% and 1.1%, respectively. Of all the factors evalu- ated in this study, only the old age was associated with a higher incidence of renal insufficiency. Of course, it should be pointed out that sufficient data was not available in relation to other possible con- comitant diseases in these victims. The mean ages of victims reported did not the same in different stud- ies (9-12). Given the fact that hospital evaluation in the present study admits only adult patients, the mean age of 35 years seems to be acceptable. In terms of sex distribution, location of the bite, and the mortality rate this study is consistent with pervious one(4, 13). Preparation and implementation of an educational program to increase people’s awareness about the importance and the necessity of attention to scorpi- on bite might help decrease the incidence. It appears that some precautions can decrease the number of scorpion bite cases, including repairing and closing cracks and splits in buildings, keeping wood logs and chips, and motes away from homes and rural resi- dential areas as well as avoiding sleeping outdoors. Acknowledgement: The authors would like to thank all the colleagues who helped in different stages of the present study, from data collection to preparation of the report. 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