Continuous intravenous midazolam infusion for Centruroides exilicauda scorpion envenomation

R. Gibly, M. Williams, Frank G Walter, J. McNally, C. Conroy, R. A. Berg

Research output: Contribution to journalArticle

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Abstract

Study objective: We sought to describe the effects of continuous intravenous midazolam infusion as therapy for severe bark scorpion (Centruroides exilicauda) envenomation. Methods: A retrospective chart review from July 1, 1993, through January 1, 1998, identified all patients treated at a university hospital with International Classification of Diseases, Ninth Revision, codes 989.5 (toxic effect of venom) or E905.2 (scorpion sting causing poisoning). By using standardized collection forms, data were extracted from the medica record of every patient who had a grade III or IV envenomation and was treated with a continuous intravenous midazolam infusion. Results: Our search identified 104 patients; 34 had grade III or IV envenomation. Of these, 33 were treated in the ICU with continuous intravenous midazolam infusion. Median patient age was 4 years (range, 1 to 68 years). Midazolam dosage was adjusted to induce a light sleep state to control agitation and involuntary motor activity. The median amount of midazolam resulting in the first recorded decrease in agitation and involuntary motor activity was 0.30 mg/kg (range, 0.03 to 1.76 mg/kg). This first evidence of clinical improvement was recorded as 1.00 hour (median), with a range of 0.00 to 3.75 hours. The initial midazolam infusion rate was 0.10 mg · kg-1 · h-1 (median), with a range of 0.01 to 0.31 mg · kg- 1 · h-1. The maximal midazolam infusion rate was 0.30 mg · kg-1 · h- 1 (median), with a range of 0.06 to 1.29 mg · kg-1 · h-1. The median time until the maximal midazolam infusion rate was 2.5 hours (range, 0.00 to 8.50 hours). The median duration of infusion was 9.50 hours (range, 4.25 to 20.50 hours). The median length of stay in the ICU was 15.17 hours (range, 6.0 to 28.0 hours), and 85% of patients were discharged directly home. All patients had resolution of abnormal motor activity and agitation during their midazolam infusion. Transient hypoxemia without evidence of end-organ dysfunction was documented in 4 patients during midazolam therapy. Conclusion: A continuous intravenous midazolam infusion can be a safe, effective, and readily available treatment option for patients with grade III or IV C exilicauda envenomation.

Original languageEnglish (US)
Pages (from-to)620-625
Number of pages6
JournalAnnals of Emergency Medicine
Volume34
Issue number5
DOIs
StatePublished - 1999

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Scorpions
Midazolam
Intravenous Infusions
Motor Activity
Scorpion Stings
Poisons
Venoms
International Classification of Diseases
Poisoning
Length of Stay
Sleep
Therapeutics

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Continuous intravenous midazolam infusion for Centruroides exilicauda scorpion envenomation. / Gibly, R.; Williams, M.; Walter, Frank G; McNally, J.; Conroy, C.; Berg, R. A.

In: Annals of Emergency Medicine, Vol. 34, No. 5, 1999, p. 620-625.

Research output: Contribution to journalArticle

Gibly, R. ; Williams, M. ; Walter, Frank G ; McNally, J. ; Conroy, C. ; Berg, R. A. / Continuous intravenous midazolam infusion for Centruroides exilicauda scorpion envenomation. In: Annals of Emergency Medicine. 1999 ; Vol. 34, No. 5. pp. 620-625.
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abstract = "Study objective: We sought to describe the effects of continuous intravenous midazolam infusion as therapy for severe bark scorpion (Centruroides exilicauda) envenomation. Methods: A retrospective chart review from July 1, 1993, through January 1, 1998, identified all patients treated at a university hospital with International Classification of Diseases, Ninth Revision, codes 989.5 (toxic effect of venom) or E905.2 (scorpion sting causing poisoning). By using standardized collection forms, data were extracted from the medica record of every patient who had a grade III or IV envenomation and was treated with a continuous intravenous midazolam infusion. Results: Our search identified 104 patients; 34 had grade III or IV envenomation. Of these, 33 were treated in the ICU with continuous intravenous midazolam infusion. Median patient age was 4 years (range, 1 to 68 years). Midazolam dosage was adjusted to induce a light sleep state to control agitation and involuntary motor activity. The median amount of midazolam resulting in the first recorded decrease in agitation and involuntary motor activity was 0.30 mg/kg (range, 0.03 to 1.76 mg/kg). This first evidence of clinical improvement was recorded as 1.00 hour (median), with a range of 0.00 to 3.75 hours. The initial midazolam infusion rate was 0.10 mg · kg-1 · h-1 (median), with a range of 0.01 to 0.31 mg · kg- 1 · h-1. The maximal midazolam infusion rate was 0.30 mg · kg-1 · h- 1 (median), with a range of 0.06 to 1.29 mg · kg-1 · h-1. The median time until the maximal midazolam infusion rate was 2.5 hours (range, 0.00 to 8.50 hours). The median duration of infusion was 9.50 hours (range, 4.25 to 20.50 hours). The median length of stay in the ICU was 15.17 hours (range, 6.0 to 28.0 hours), and 85{\%} of patients were discharged directly home. All patients had resolution of abnormal motor activity and agitation during their midazolam infusion. Transient hypoxemia without evidence of end-organ dysfunction was documented in 4 patients during midazolam therapy. Conclusion: A continuous intravenous midazolam infusion can be a safe, effective, and readily available treatment option for patients with grade III or IV C exilicauda envenomation.",
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