Levosimendan treatment in a child with treatment-resistant left ventricular systolic dysfunction after scorpion sting

• Published in: Hong Kong journal of emergency medicine 2020-07, Vol.27 (4), p.245-249
• Main Authors: Ahmet Yontem, Riza Dincer Yildizdas, Ozden Ozgur Horoz, Nagehan Aslan, Merve Misirlioglu, Hayri Levent Yılmaz, Sevcan Erdem
• Format: Article
• Language: English
• Subjects: Antivenins; Antivenom; Bites and stings; cardiotonic agents; Children; Diseases; Echocardiography; ejection fraction; Pediatrics; Scorpions; Treatment
• ISSN: 1024-9079; 2309-5407
• DOI: 10.1177/1024907919827195

Background: Scorpion stings are common in countries dominated by rural and coastal settlements with temperate climate. Scorpion stings are usually harmless and can be seen in local findings, but in some cases, systemic, neurotoxic, and cardiotoxic findings can be seen. Case report: A 3 year 7 month old girl was referred to pediatric emergency care 2 h after yellow scorpion (species of Leiurus abdullahbayrami) sting. In our case, cardiac function insufficiently progressed in spite of the standard inotropic and milrinone treatment. On the third day of hospitalization, levosimendan was initiated with good clinical effect. Conclusion: In the literature, the use of levosimendan in pediatric patients has been limited to those with low cardiac output syndrome after cardiovascular surgery. The use of levosimendan in children with scorpion sting has been previously reported only in Banille et al.’s study. Scorpion antivenom should be administered intravenously as soon as possible in cases of systemic findings that develop after scorpion stings. This report suggests that levosimendan is temporally associated with improvement in patients who have severe cardiac dysfunction due to scorpion sting and refractory to current treatment.