Table of contents
Scorpion envenomation
Background
Overview
Definition
Scorpion stings in the US are caused by Centruroides scorpions from the Buthidae family. Hemiscorpius lepturus, found in the Middle East and native to Iran, is the only scorpion outside the family Buthidae that is venomous to humans.
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Pathophysiology
Centruroides venom contains a mixture of different toxins, including α-toxins that affect sodium channels, causing neuromuscular toxicity and autonomic dysfunction.
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Epidemiology
Scorpion stings most commonly occur in tropical and subtropical regions, with a global incidence of 20 per 100,000 person-years.
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Disease course
Most scorpion stings cause only localized toxin-related cutaneous effects, such as burning pain, swelling, erythema, paresthesia, muscle fascilutations, and necrosis. In severe cases, neuromuscular toxicity may include cranial nerve or somatic skeletal neuromuscular dysfunction, which may be accompanied by autonomic dysfunction, such as cholinergic or adrenergic effects. Hemiscorpius lepturus envenomations can cause local skin necrosis and, in severe cases, hemolysis, DIC, and renal failure.
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Prognosis and risk of recurrence
Most scorpion stings are mild, causing only localized reaction, with approximately 5-10% of cases leading to severe envenomation, which is more common in children.
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Guidelines
Key sources
The following summarized guidelines for the management of scorpion envenomation are prepared by our editorial team based on guidelines from the American Red Cross (ARC/AHA 2024) and the American Academy of Family Physicians (AAFP 2022).
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Medical management
Supportive therapy: as per AHA/ARC 2024 guidelines, consider offering OTC acetaminophen and nonsteroidal anti-inflammatory agents to alleviate local pain from scorpion stings.
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Antivenom
Patient education
Education on first aid: as per AHA/ARC 2024 guidelines, educate patients on the following:
call emergency services if a person stung by a scorpion develops symptoms throughout the body, such as difficulty breathing, muscle rigidity, dizziness, or confusion
seek medical care if pain from a scorpion sting extends beyond the site of the bite/sting, becomes severe, and is not controlled by OTC pain medications; if an open wound develops; or if the person experiences symptoms throughout the body.
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