Scorpion envenomation
Background
- Most scorpion stings in North America result only in local pain.
- Arizona Bark Scorpion, Centruroides sculpturatus, found in AZ, NM, TX, and CA, can cause systemic toxicity.
Clinical Features
- Local reaction
- Immediate and severe pain
- Systemic reaction
- Uncommon but can be severe, particularly in children
- Cranial nerve and somatic motor dysfunction can develop:
- Abnormal roving eye movements (pathognomonic) , blurred vision, pharyngeal muscle incoordination
- Can occasionally lead to respiratory compromise (excessive secretion)
- Tachycardia and severe agitation can also be present
- Grades of Centruroides envenomation
- Grade 1 - Local pain and/or paresthesias at site of envenomation
- Grade 2 - Pain and/or paresthesias remote from the site of the sting, in addition to local findings
- Grade 3 - Either cranial nerve/autonomic dysfunction or somatic skeletal neuromuscular dysfunction
- Cranial nerve dysfunction - Blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysphonia, problems with upper airway
- Somatic skeletal neuromuscular dysfunction - Restlessness, severe involuntary shaking or jerking of the extremities that may be mistaken for a seizure
- Grade 4 - Combined cranial nerve/autonomic dysfunction and somatic nerve dysfunction
- Without antivenom, symptoms typically last 24-48 hrs
Treatment
- Apply ice to area of sting
- Atropine
- May be given for hypersalivation and respiratory distress caused
- Contraindicated for foreign scorpion stings because may exacerbate adrenergic effects
- May be given for hypersalivation and respiratory distress caused
- Antivenom
- Resolves clinical syndrome within 4hr
See Also
Source
Tintinalli
Medscape: Scorpion Envenomation Treatment & Management. http://emedicine.medscape.com/article/168230-treatment.