Scorpion Stings – Diagnosis and Treatment

Dr. Balakrishna Vedulla
MBBS, DEM, MRCEM
Consultant- Emergency Medicine – HOD
Apollo Hospitals, Visakhapatnam

Scorpions often make their homes in the crevices inside homes. Scorpions also live in other small spaces such as under rocks and in firewood. They are incredibly territorial. If you come across a scorpion unexpectedly, the chances are that it may inject venom into your body to defend itself.

For patients presenting with scorpion stings, the following need to be asked:

• Time of the sting
• Nature of the incident
• Local and Systemic symptoms

Most scorpion stings are not harmful and only cause pain around the area that was stung. But the more dangerous scorpion stings can be life-threatening.

Symptoms

Symptoms may include, but are not limited to:

• Numbness all over body
• Breathing difficulty
• Difficulty swallowing
• Swollen tongue and excessive salivation
• Nausea and Vomiting
• Slurred speech
• Restlessness
• Seizures
• Blurry vision
• Muscle twitching
• Rotary eye movements
• Hypotension
• Bradycardia
• Involuntary bowel or bladder movements
• Anaphylactic reactions

Toxicity

Toxicity can be dependant on:

• Sting Site – More proximal to head and/or torso, quicker envenomation
• Number of Stings
• Depth of the sting penetration
• Age of the victim
• Body weight
• Presence of comorbidities

Investigations

Investigations include Complete Blood Counts, Urinalysis and Metabolic Panel with Clotting Profile. ABG is indicated in the setting of respiratory or metabolic derangement.

Treatment

Treatment for scorpion stings depends on the type of scorpion involved and the amount of venom injected. Mild stings may be managed at home by:

• Cleaning the site with water
• Applying ice

More serious symptoms may need an anti-venom. It is important to receive antivenom as soon as possible after serious symptoms appear.

Treatment in the ER

Assess the patient, using the ABC approach. Monitor vital signs. Protect airway at the earliest sign of respiratory distress or altered mental status.

• Ice compresses
• Immobilization of the affected part(s)
• Position sting sites below the heart level
• Reassure the patient and keep them calm
• Local wound care as described above
• Tetanus Prophylaxis
• Systemic Antibiotics
• IV Crystalloids
• Anti-venom if available

Further in-patient care may be required if the patient is unstable or has signs of significant envenomation. Any and all patients with significant envenomation, and especially children need to be monitored in an ICU setting.

Prevention

Scorpions are more active at night, but one can get stung any time. The risk can be lessened by wearing long sleeves, pants, protective shoes and gloves when outside in areas where scorpions live. In these areas, it is also a good idea to shake out shoes and clothing before putting them on.