Successful management of third-trimester scorpion envenomation (Parabuthus maximus) in a resource-limited setting: A case report

Table 1 Full hemogram findings

Parameter	Units	Results	Reference range
WBC	× 109/L	4.69	4.0-10.8
Neutrophils	%	32.8	40-75
Lymphocytes	%	59.9	21-40
Monocytes	%	5.4	3-12
Eosinophils	%	1.4	0.5-5
Basophils	%	0.5	0.5-5
RBC	× 109/L	4.56	4.7-6.1
HB	g/dL	12.6	11.2-16.0
HCT	%	38.3	37.0-47.0
MCV	fL	83.9	76.0-100.0
MCH	Pg	27.5	27.0-31.0
MCHC	g/dL	32.8	32.0-36.0
RDW-C	%	13.8	11.5-14.5
Platelets count	× 109/L	202	160.0-450.0
MPV	fL	9.1	6.5-12.0
PDW	%	15.9	9.0-17.0
PCT	%	0.228	0.108-0.282

RBC: Red blood cells; HB: Haemoglobin; HCT: Haematocrit; MCV: Mean corpuscular volume; MCH: Mean corpuscular haemoglobin; MCHC: Mean corpuscular haemoglobin concentration; RDW-CV: Red cell distribution width - coefficient of variation; MPV: Mean platelet volume; PDW: Platelet distribution width; PCT: Plateletcrit.

Table 2 Liver function test findings

Parameter	Units	Results	Reference range
Albumin	g/L	36.33	35-52
ALP	U/L	38.1	35-104
ALT	U/L	34.2	0-40
AST	U/L	33.9	0-32
GGT	U/L	6.7	5-36
Total protein	g/L	68.4	66-87

ALP: Alkaline phosphatase; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; GGT: Gamma-glutamyl transferase.

Table 3 Urea, creatinine, and electrolytes findings

Parameter	Units	Results	Reference range
Chloride	mmol/L	101.5	95-107
Creatinine	µmol/L	68	44-80
Potassium	mmol/L	3.86	3.5-5.1
Sodium	mmol/L	135.7	135-145
Urea	mmol/L	4.64	2.76-8.07

Table 4 C-reactive protein findings

Parameter	Units	Results	Reference range
CRP	mg/L	75.2	0-10.0

CRP: C-reactive protein.

Table 5 Literature review

Ref.	Country	Trimester	Management	Maternal outcome	Fetal outcome
Najafian et al[2], 2020	Iran	All	Antivenom administered 6-12 hours post-sting; supportive care	Stable	11% neonatal complications; Apgar < 8 in 11.3% of preterm births
Ben Nasr et al[8], 2009	Tunisia	All	Supportive care; antivenom use recommended	Stable	Risk of preterm birth, fetal anomalies, and long-term developmental issues
Kaplanoglu and Helvaci[6], 2015	Turkey	All	Symptomatic care (no antivenom)	Stable	All live births
Leibenson et al[7], 2009	Israel	3rd	Supportive care	Stable	Stillbirth
Brown et al[10], 2013	Review	All	Supportive care; antivenom for severe cases	Optimal outcomes with early intervention	Improved fetal outcomes with maternal stabilisation
Present case, 2025	Kenya	3rd	Early antivenom; multidisciplinary care	Full recovery	Healthy neonate

Table 6 Key considerations in scorpion envenomation during pregnancy

Aspect	Clinical implications
Pathophysiology	Catecholamine-induced uteroplacental vasoconstriction leading to fetal hypoxia
Maternal symptoms	Autonomic storm (hypertension, tachycardia), local pain, potential for severe complications (eclampsia, myocarditis)
Fetal effects	Tachycardia, distress, potential preterm labor or demise in severe cases
Critical management	Prompt antivenom administration, multidisciplinary care, and continuous fetal monitoring
Resource-limited challenges	Antivenom accessibility, harmful traditional practices, and delayed presentation