Scorpion Envenomation Follow-up

  • Author: David Cheng, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 9, 2011
 

Further Inpatient Care

  • Inpatient care is dictated by the severity of the envenomation and consists of stabilizing the patient, neutralizing the venom, providing supportive therapies, and preventing complications. Patients with grade III or grade IV Centruroides stings and other severe Buthidae envenomations should be admitted to the intensive care unit (ICU) and/or treated with antivenom.
  • Treat all patients with severe systemic symptoms in an intensive care unit (ICU) setting because of the unpredictability of the symptomology, the risks associated with antivenin administration, and the need for airway or blood pressure support.
  • Young children do worse than adults. Young children may not recover as quickly as adults after scorpion envenomation and are more likely to require observation.
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Further Outpatient Care

  • Patients displaying local nonascending reactions to the venom may be discharged after 6 hours of observation, with close follow-up. If the patient was treated with a pressure bandage, the symptoms may be delayed and inpatient observation is warranted.
    • Patients with grade I or grade II Centruroides envenomations may be discharged.
    • Discharge of patients with other Buthidae envenomations is more problematic because onset of systemic symptoms may be delayed up to 24 hours.
  • If an antivenin is administered, monitor the patient for serum sickness over next the few weeks.
  • Inform the patient about the possibility of persistent pain or paresthesia at the sting site.
  • Instruct patient regarding progression. Discuss symptoms of delayed serum sickness with patients treated with antivenom.
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Inpatient & Outpatient Medications

  • Give steroids and antihistamines if serum sickness develops.
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Transfer

  • Transfer is appropriate if antivenin administration or ICU treatments are not available at the institution where the patient initially presents.
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Deterrence/Prevention

  • Protective clothing, such as shoes or gloves, may prevent some scorpion envenomations. Check shoes, gloves, clothing, and backpacks for scorpions prior to use.
  • Keep yards free of debris, which can serve as a place for scorpions to hide.
  • Make sure windows and doors fit tightly to prevent scorpions from entering the house.
  • Avoid walking barefoot, especially at night when scorpions are active.
  • Use a Wood lamp at night because the cuticle of the Centruroides species is fluorescent under ultraviolet light.
  • Methods of biological control of scorpions include introducing chickens, ducks, and owls to the area.
  • Methods of chemical control of scorpions include using organophosphates, pyrethrins, and chlorinated hydrocarbons.
  • Government monitoring of the scorpion public health problem.
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Complications

Complications of scorpion envenomation may include the following:

  • Dilated cardiomyopathy
  • Ankylosis of small joints if the sting occurs at a joint
  • Rhabdomyolysis
  • Persistent paresthesia
  • Antivenin anaphylaxis and serum sickness
  • Iatrogenic, high-dose, sedative-hypnotic respiratory arrest
  • Respiratory arrest
  • Cardiac arrest
  • Shock
  • Seizures
  • Rhabdomyolysis
  • Death
  • Defibrination after M tamulus stings
  • Hemolysis after H lepturus stings
  • Pancreatitis after T trinitatis stings
  • Antivenom-associated reactions
  • Renal failure
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Prognosis

  • Prognosis is dependent on many factors, including species of scorpion, patient health, and access to medical care. Most patients recover fully after scorpion envenomation.
  • Symptoms generally persist for 10-48 hours. If the victim survives the first few hours without severe cardiorespiratory or neurologic symptoms, the prognosis is usually good. Furthermore, surviving the first 24 hours after a scorpion sting also carries a good prognosis.
  • A worse prognosis can be expected with the presence of systemic symptoms such as cardiovascular collapse, respiratory failure, seizures, and coma. Specifically, the following were associated with poor outcomes: Glasgow Coma Score less than 8 (odds ratio [OR], 9.87) and pulmonary edema (OR, 8.46).[18]
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Patient Education

  • Educate all patients about methods to avoid scorpions (see Deterrence/Prevention).
  • Delays in seeking medical treatment are associated with higher likelihood of mortality in children and adolescents.[19]
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Contributor Information and Disclosures
Author

David Cheng, MD  Associate Professor of Emergency Medicine, Education Director, Associate Emergency Medicine Residency Director, Case Medical Center

David Cheng, MD is a member of the following medical societies: American College of Emergency Physicians, American Heart Association, Council of Emergency Medicine Residency Directors, International Society for Mountain Medicine, National Association of EMS Physicians, Society for Academic Emergency Medicine, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Coauthor(s)

Judith A Dattaro, MD, FACEP  Assistant Professor of Emergency Medicine in Surgery, Cornell University Medical College; Consulting Staff, Department of Emergency Medicine, Weill-Cornell University Medical Center, New York Presbyterian Hospital

Judith A Dattaro, MD, FACEP is a member of the following medical societies: American Association of Women Emergency Physicians, American College of Emergency Physicians, American Medical Association, Chicago Medical Society, Illinois State Medical Society, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Ramy Yakobi, MD, MBA  Medical Director, Department of Emergency Medicine, Beth Israel Medical Center

Ramy Yakobi, MD, MBA is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Sean P Bush, MD, FACEP  Professor of Emergency Medicine, Loma Linda University School of Medicine; Consulting Staff, Envenomation Specialist, Department of Emergency Medicine, Loma Linda University Medical Center

Sean P Bush, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, International Society on Toxicology, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Protherics Consulting fee Consulting; Nycomed (formerly Fougera) Grant/research funds Speaking and teaching; Rare Disease Therapeutics Grant/research funds Research; Bioclon Grant/research funds Research

Charles J Gerardo, MD, FACEP  Associate Professor, Department of Surgery, Division of Emergency Medicine, Duke University School of Medicine; Director of Clinical Affairs, Division of Emergency Medicine, Duke University Medical Center

Charles J Gerardo, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, Council of Emergency Medicine Residency Directors, National Hispanic Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Lisa Kirkland, MD, FACP, CNSP, MSHA  Assistant Professor, Department of Internal Medicine, Division of Hospital Medicine, Mayo Clinic; ANW Intensivists, Abbott Northwestern Hospital

Lisa Kirkland, MD, FACP, CNSP, MSHA is a member of the following medical societies: American College of Physicians, Society of Critical Care Medicine, and Society of Hospital Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H  Professor, Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Southern California Keck School of Medicine

Om Prakash Sharma, MD, FRCP, FCCP, DTM&H is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Osler Society, American Thoracic Society, New York Academy of Medicine, and Royal Society of Medicine

Disclosure: Nothing to disclose.

Timothy D Rice, MD  Associate Professor, Departments of Internal Medicine and Pediatrics and Adolescent Medicine, St Louis University School of Medicine

Timothy D Rice, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Physicians

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD  Attending Physician, Department of Emergency Medicine, Cambridge Health Alliance, Division of Emergency Medicine, Harvard Medical School

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Centruroides limbatus, identified by Scott Stockwell, PhD. A small barb at the base of the stinger may be helpful in identifying Centruroides or Tityus species, although its presence is variable. Photo by Sean Bush, MD.
Centruroides species. Note the slender pincers generally characteristic of scorpions from the family Buthidae. Photo by Sean Bush, MD.
Scorpions from the family Buthidae (which includes almost all of the potentially lethal scorpions) generally can be identified by the triangular sternal plate. In other families of scorpions, this feature is more square or pentagonal. Photo by Sean Bush, MD.
 
 
 
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