Scorpion Stings
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: T63.2 DESCRIPTION Some scorpion species can cause serious systemic toxicity. Thick-tailed scorpions with small pincers are extremely toxic, resulting in both local and systemic features. Thin-tailed scorpions with large pincers are much less toxic and usually cause local symptoms only. D
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: T63.2
DESCRIPTION
Some scorpion species can cause serious systemic toxicity. Thick-tailed scorpions with small pincers are extremely toxic, resulting in both local and systemic features. Thin-tailed scorpions with large pincers are much less toxic and usually cause local symptoms only.
DIAGNOSTIC CRITERIA
- Pain and paraesthesia occur immediately after envenomation.
- Autonomic and motor findings may differentiate scorpion bites from other causes of pain.
- In severe cases cranial nerve dysfunction, blurred vision, pharyngeal muscle incoordination, drooling and respiratory compromise can occur.
- Excessive motor activity may present as restlessness, or uncontrollable jerking of extremities.
- Nausea, vomiting, tachycardia and severe agitation can also occur.
- Other serious effects include cardiac dysfunction, pulmonary oedema, and pancreatitis.
GENERAL AND SUPPORTIVE MEASURES
- If unidentified scorpion or confirmed thick-tailed scorpion, observe for a minimum of 12 hours in hospital.
- Monitor airway, breathing and circulation.
- Ventilatory support may be required.
MEDICINE TREATMENT
For pain:
- Paracetamol, oral, 15 mg/kg/dose, 6 hourly as required.
Very painful scorpion stings
- Lidocaine (lignocaine) 2%, 2 mL injected around the sting as a local anaesthetic.
Caution
Opiates increase the risk of respiratory depression and if required, should only be used with caution in severe uncontrolled pain.
For muscle cramps:
- Calcium gluconate 10%, IV, 0.5 mL/kg by slow intravenous injection.
- Give 0.5–1 mL/minute.
- Monitor ECG.
- Monitor response and repeat as needed
If not immunised in the past 5 years:
- Tetanus toxoid, IM, 0.5 mL.
Complete course in previously unvaccinated patients.
Antivenom therapy
Antivenom therapy is recommended only in cases with systemic signs.
Obtainable from South African Vaccine Producers (Tel.: +2711 386 6063/2/78 or after hours 071 680 9897 or 082 884 2971). See full details in the package insert.
- Scorpion antivenom, slow IV, 10 mL administered over 3–5 minutes. If consistency is too thick, can be diluted in sodium chloride or 5% dextrose.
CAUTION
Never administer antivenom without being prepared to manage acute anaphylaxis.
REFERRAL
- Severe cases requiring intensive care.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 18: Poisoning, 18.2 Envenomation, 18.2.2 Scorpion Stings