To the Editor: We wish to thank Rashid and Hossain for their interest in our paper on scorpion envenomation in Marjadah children, Asir Region [1]. Their experience on the same topic in children in the Northwestern region of Saudi Arabia [2] conforms, essentially, with the pattern found in other parts of the Kingdom [1,3,4], as far as general clinical manifestation and complications are concerned.

The statement in our paper that children below the age of four years are more susceptible to the effect of scorpion sting [5] does not necessarily exclude the possibility of severe complications and death beyond this age as shown in their study [2]. In our review [1], although mortality was nil, eight out of 19 children who presented with severe symptoms were in the age group 4-12 years. What perhaps is more significant is that the duration of symptoms is inversely related to the patient's age [6]. Furthermore, it appears likely that the effect of the same quantity of toxin introduced by a sting will be more lethal in an infant or toddler than an older child or adult.

The issue of consumption coagulopathy complicating scorpion sting in one of their patients who died is quite intriguing. The study by Brennan et al on adults who were stung by scorpions revealed only mild abnormalities in the coagulative functions of the blood[4], whereas El-Amin and Ul-Din-Khan did not encounter any hematological problems in a prospective study on children [7]. Without outright dismissal of the possibility of severe hematological dysfunction in scorpion envenomation, it must be borne in mind that several other clinical conditions including shock, acidosis, and hypoxia may also induce disseminated intravascular coagulopathy (DIC).

In conclusion, it cannot be overemphasized that careful monitoring of affected children is very vital and that overtreatment can be counterproductive. According to Neale [3], "conservative symptomatic management is the most desirable" and Rimsza et al [6] warn against the "temptation to totally control the restlessness" of a child with scorpion envenomation.