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Chapter-33 Pediatric Envenomations

BOOK TITLE: The Short Textbook of Pediatrics

Author
1. Gupte Suraj
2. Kaushal RK
ISBN
9788184484694
DOI
10.5005/jp/books/10983_33
Edition
11/e
Publishing Year
2009
Pages
4
Author Affiliations
1. Maharaja Agrasen Medical College, Agroha, Hisar, India, Mamata Medical College and General and Super Specialty Hospitals, Khammam, Telangana, India, Mamata Medical College/Mamata General and Superspeciality Hospitals, Khammam, Telangana, South India, Mamata Medical College/Mamata, General and Superspecialty Hospitals, Khammam, Telangana, India, Postgraduate Department of Pediatrics Mamata Medical College and Hospital Khammam, Andhra Pradesh, India, Mamata Medical College/Mamata General and Superspecialty Hospitals, Khammam 507002, Andhra Pradesh, India, Mamata Medical College/Mamata General and Superspecialty Hospitals, Khammam, Andhra Pradesh, India, Mamata Medical College and Hospitals, Khammam, Andhra Pradesh, India, Narayana Medical College/Narayana General and Superspeciality Hospitals, Nellore 524002, AP, South India, Narayana Medical College and Hospital, Nellore, AP, India, Narayana Medical College/Narayana General and Superspeciality Hospitals, Nellore, Andhra Pradesh (India), Children’s Health Cen
2. Indira Gandhi Medical College, Shimla, R P Medical College, Tanda at Dharamshala, India, Government Medical College, Dharamshala, India, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
Chapter keywords

Abstract

Right at the outset of the Chapter is a description of snake bite, a common emergency, particularly in children living in slums and villages. There are three types of poisonous snakes seen in India are neurotoxic. First: neurotoxic cobra which causes paralysis of muscles of eyes (ptosis), palate, jaws, tongue, larynx, neck, deglutition and chest, eventually leading to respiratory failure. Cardiotoxicity (hyportension, tachycardia, ECG changes) and hemolysis may also occur. Onset of manifestations is rapid. Second: Hemorrhagic hemotoxic viper which causes tissue necrosis and hemorrhage though onset of symptoms is rather slow. Third: neurohemotoxic krait containing both neuro and hepatotoxins. This is the most common and dangerous poisonous snake in India. A detailed account of snake poisoning with reference to clinical features, laboratory investigations, grading of envenomation, treatment measures including AVS details with desensitization technique, and complications is given. Details of scorpion sting with emphasis on clinical features of autonomic storm and management are provided, pointing out that treatment needs to be directed to relieving pain, anxiety, suppress autonomic storm, correction of hypovolemia and pulmonary edema. Prazosin is the first line management for autonomic storm. The olden modalities such as lytic cocktail, morphine, steroids, atropine, nifedipine and ACE inhibitors are of no use.

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