Scorpions are a common arthropod found all over the world. If threatened, a scorpion may use its long, flexible tail to sting a potential predator. Frequently, people unknowingly come into contact with these species and experience the painful sensation of envenomation

1. Scorpion Poisoning
Tharuka Fernando
Karen Wickremasekara
Rivindu Wickramanayake

2. Introduction
• Scorpions are a common arthropod found
all over the world.
• If threatened, a scorpion may use its long,
flexible tail to sting a potential predator.
• Frequently, people unknowingly come into
contact with these species and experience
the painful sensation of envenomation.

4. Red & Black Scorpion

5. 93
Scorpion Bite
• 2 Types of Scorpion
• Black – 99% -- Pain is severe ,but not
fatal .
• Red Scorpion – found in
Guhagar,Chiplun ,Kokan area of
Maharashtra state of India,Pondechari
• This bite can be Fatal

6. Etiology
• While there are thought to be about 1750
species of scorpions in the world, only 25
are considered to be lethal to humans.
• In most cases, the sting of a scorpion causes
pain but is relatively harmless to a healthy
adult.
• Species found in Asia, Africa, and South
America may need medical attention due to
the potential toxic effects of their venom.

7. Epidemiology
• The effect of the scorpion sting is highly
dependent on the species.
• Species like Centruroides and Parabuthus
cause neuromuscular issues, Buthus,
Mesobuthus, & Androctonus exhibit life-
threatening cardiovascular effects.
• These worrisome effects are mostly seen in
the elderly and even more so in infants and
young children.

8. Pathophysiology
• Grade 1: Local pain and paresthesias at the sting site.
The puncture wound may not be noticeable in this
grade. The "tap test" may confirm a provider's
suspicion by distracting the patient and tapping on the
area of the sting, causing increased pain. This does
not occur with other species. Care is limited to
analgesia.
• Grade 2: Local pain and paresthesias at the sting site
as well as proximally. Recommended care again
includes analgesia with optional anxiolytics if needed.

9. CONT..
• Grade 3: Grade 2 with added cranial nerve (increased
oral secretions, blurry vision, rapid tongue movement,
nystagmus) or skeletal neuromuscular dysfunction
(flailing of the extremities and tetanus-like arching of
the back). These patients require analgesia and
anxiolytics as well as anti-venom.
• Grade 4: Unlike grade 3 envenomation where the
patient will experience either cranial nerve or skeletal
muscle dysfunction, grade 4 envenomation include both.
This can cause hyperthermia, rhabdomyolysis,
pulmonary edema, and multiple organ failures. Again,
anti-venom is critical in this situation.

10. Symptoms of Scorpion Bite
• Local – more severe than snake bite –
• pain, oedema & reddening
• Systemic – Nausea, vomiting, restlessness,
fever ,convulsions, coma, cyanosis
• The site of the bite is identified as –
Pinpoint puncture spot ,local sweating &
oedema
97

11. Toxicokinetics
• Less than 10% of scorpion stings cause systemic
symptoms & can be serious.
• Neurotoxins are the mainstay of symptomatology
in envenomation.
• The venom of some species can cause prolonged
depolarization by causing incomplete inactivation
of sodium channels resulting in a slow influx of
sodium.
• This then leads to membrane hyper-excitability and
unregulated axon firing.

13. History and Physical
• Most scorpion stings cause a local inflammatory
reaction and pain.
• Seizure-like activity in the patient .
• Motor hyperactivity of the pharyngeal muscles and
uncontrolled diaphragmatic and intercostal
neuromuscular activity may be seen.
• Cardiopulmonary effect
• Tachycardia
• Pulmonary edema,
• Cardiogenic shock

14. Evaluation
• History and physical most commonly diagnose
scorpion stings.
• Usually, the patient can visualize the scorpion, and
the practitioner will observe an erythematous area
on the skin with local inflammation.
• Numbness and weakness at the site may also be
seen.
• CBC, CMP, PT/INR, PTT, and lipase.
• Laboratory studies are usually reserved for patients
with severe (grade 3 to 4) envenomations.

15. Management
• Most stings only require supportive therapy including
ibuprofen, cleaning of the sting area, and tetanus prophylaxis.
• Patients should be observed for at least 4 hours, but the
onset of life-threatening symptoms occurs much quicker in
children, with an average of 14 minutes.
• In patients with severe envenomation displaying symptoms
such as hypersalivation, clonus, rapid eye movements, or
restlessness, immediate intervention is critical.
• These patients may need endotracheal intubation due to the
possibility of rapid onset severe pulmonary edema.
• As cardiogenic shock can complicate this, administration of
dobutamine has been shown to be helpful.

16. CONT..
• Intravenous benzodiazepines may be used if the patient
displays muscle spasticity.
• Antivenom is reserved for patients displaying skeletal muscle
or cranial nerve dysfunction who are stung by Centruroides
scorpions. It is available in the United Staes, under the name
Anascorp, which is intravenous scorpion-specific F(ab’)2
equine antivenom. The recommended dose is three vials,
followed by an additional two if symptoms continue.
• Complications are low and comprise mostly serum sickness
(0.5%). Anascorp is considered much safer than the previous
antivenom, which was marketed in 1965 and taken off
shelves in 2001 due to its high rates of anaphylaxis (3.4%). .

18. If a patient is observed for 4 hours and is
determined to have a mild sting, is
tolerating oral intake, and has adequate
pain control, the patient may be safely
discharged home with return precautions.