Treatment of Scorpion Sting

Note: "Scorpion bite" is technically a sting - the venom is delivered by the stinger at the tail tip, not the claws.

Step 1 - First Aid (All Cases)

• Move the patient away from the scorpion.
• Keep the patient calm and still - movement increases venom absorption.
• Apply a cold pack / ice pack (wrapped in cloth) to the sting site for 10-20 minutes at a time to reduce pain and slow venom absorption.
• Apply a pressure bandage above the site if the limb is affected; loosen it for 1-2 minutes every 10-15 minutes.
• Do not apply tourniquets tightly for prolonged periods or attempt incision and suction - these are outdated and ineffective.
• Call emergency services or get to a hospital immediately.

Step 2 - Assess Severity

• The tap test: tapping the sting site causes intense hyperesthesia - a hallmark of Centruroides envenomation.
• Children and elderly are at highest risk for severe toxicity and death (from respiratory arrest or pulmonary edema).

Step 3 - Hospital/Emergency Management

A. Supportive Care (all cases)

• Secure airway, breathing, circulation (ABC).
• IV access and continuous monitoring (ECG, pulse oximetry, BP).
• Analgesics for pain relief.
• Antihistamines for local allergic reactions.

B. Sedation for Neuromuscular Symptoms

• Midazolam IV (continuous infusion) is the drug of choice to control agitation, involuntary muscle jerking, and twitching caused by neurotoxic scorpion envenomation.
• Sedatives and opioids (e.g., morphine) help with neuromuscular symptoms but must be used carefully as they can depress respiration.

C. Antivenom

• The most effective treatment for severe envenomation.
• Should be given as early as possible in severe cases.
• Species-specific antivenoms are available depending on the region:
  • Centruroides sculpturatus antivenom (USA - Anascorp)
  • Region-specific antivenoms for North Africa, Middle East, India, Brazil
• In areas where severe scorpion stings occur (North Africa, Middle East, Central America, Amazonia, India), follow national/local protocols for antivenom dosing.

D. Managing Systemic Complications

E. Local Pain Relief

• Local infiltration of lignocaine around the sting site gives significant pain relief.

What to AVOID

• Calcium channel blockers, antihistamines, steroids, and diuretics should be avoided in moderate-severe cases as they can worsen cardiac complications (per UN DHMOSH guidance).
• Do not apply electric shock or cut and suck the venom.
• Do not apply tight tourniquets for extended periods without loosening.

Prevention

• Wear shoes and gloves in scorpion-endemic areas.
• Shake out shoes, clothing, and bedding before use.
• Use a flashlight at night outdoors.
• Clear debris and rocks near living spaces.

• Harrison's Principles of Internal Medicine, 22nd Ed. (2025), pp. 3778-3779
• PC Dikshit Textbook of Forensic Medicine and Toxicology, pp. 501
• Medscape - Scorpion Envenomation Treatment
• UN DHMOSH Scorpion Sting Guidance (2026)

Emergency: If stung and developing breathing difficulty, muscle spasms, drooling, blurred vision, or chest pain - go to an emergency room immediately. Do not wait.