Scorpion Sting Treatment

Step 1 - Identify the Species (Critical First Step)

• Non-lethal species (most scorpions): local pain, swelling, burning only - managed at home.
• Dangerous species requiring aggressive treatment:
  • Centruroides sculpturatus (bark scorpion, USA Southwest) - neurotoxin, sodium channel dysfunction
  • Leiurus quinquestriatus (Middle East/North Africa) - catecholamine surge, cardiac toxicity
  • Mesobuthus tamulus (India) - hypertensive crisis, pulmonary edema
  • Androctonus spp. (Mediterranean, North Africa) - cardiac/pulmonary toxicity
  • Tityus serrulatus (Brazil) - myocardial damage, acute pancreatitis
  • Hemiscorpius lepturus (Iran) - cytotoxic, hemolysis, acute kidney injury

Immediate First Aid (All Cases)

1. Keep the patient calm - reduces venom absorption
2. Apply pressure dressings and cold/ice packs to the sting site to slow venom spread
3. Loosen tourniquet (if used) for 1-2 min every 10-15 min (Dikshit approach)
4. Wash the bite area with dilute potassium permanganate, borax, or ammonia solution
5. Elevate the affected limb
6. Do NOT cut or suck the wound

For Mild/Non-Lethal Stings

For Severe/Systemic Envenomation (Emergency Management)

• IV midazolam (continuous infusion) - reduces agitation and involuntary muscle movements; preferred over opioids
• Treating neuromuscular symptoms with sedatives or opioids can suppress protective airway reflexes - use cautiously
• Airway management and monitoring are essential

• Manage hypertensive crisis, arrhythmias, and pulmonary edema with standard ICU protocols
• IV glucocorticoids for shock (500 mL 5% dextrose-saline + IM glucocorticoids)

• Calcium gluconate 10 mL of 10% solution IV - effective for severe muscular cramps

• Atropine sulfate administration

• Local infiltration of 5% lignocaine (lidocaine) in and around the bite

Antivenom (Antivenin)

• Indication: Severe systemic envenomation with cranial nerve or neuromuscular dysfunction
• Mechanism: Rapidly reverses cranial-nerve dysfunction and muscular symptoms when given IV
• FDA-approved product: Equine-derived C. sculpturatus IgG F(ab')2 antivenin (for US bark scorpion)
• Commercially prepared antivenins exist in several countries for the most dangerous local species

Grading & Disposition

Special Populations

• Young children and elderly: highest risk of fatal respiratory arrest - admit and monitor aggressively even with moderate symptoms
• Hemiscorpius lepturus stings: watch for delayed hemolysis, hemoglobinuria, and acute kidney injury developing after day 1

Key Monitoring Parameters

• Vital signs (BP, HR, SpO2)
• Neurological status (cranial nerve function, eye movements)
• Cardiac monitoring (ECG for arrhythmias)
• Renal function (especially for cytotoxic species)
• Respiratory status

• Harrison's Principles of Internal Medicine 22E (2025), pp. 3778-3779 - primary reference
• PC Dikshit Textbook of Forensic Medicine and Toxicology, p. 501

Note: Antivenom availability varies by country. Always contact your local/regional Poison Control Center for species-specific guidance and antivenom sourcing.