What is the treatment for a scorpion sting?

Treatment of Scorpion Stings

For scorpion stings, first aid treatment should include over-the-counter pain medications (acetaminophen or NSAIDs), topical lidocaine application if the skin is intact, and ice for local pain relief. 1

Initial Assessment and Triage

• Call emergency services immediately if the person develops systemic symptoms such as:

  • Difficulty breathing
  • Muscle rigidity
  • Dizziness
  • Confusion 1

• Seek medical care if:

  • Pain extends beyond the sting site
  • Pain becomes severe and is not controlled by over-the-counter medications
  • An open wound develops
  • Any systemic symptoms appear 1

First Aid Treatment

Pain Management

1. Over-the-counter medications:

   • Acetaminophen (Tylenol)
   • NSAIDs such as ibuprofen or naproxen 1

2. Topical pain relief:

   • Apply 5% lidocaine to the sting site if skin is intact 1
   • Apply ice to reduce pain and swelling 1

Wound Care

• Clean the area with soap and water
• Keep the wound clean with a sterile dressing 2
• Ensure tetanus immunization is current

Hospital-Based Treatment

For Mild to Moderate Envenomation

• Continue pain management with oral or IV analgesics
• Monitor for development of systemic symptoms
• Observe for at least 24 hours in cases of concerning symptoms 2

For Severe Envenomation

• Antivenom therapy is the cornerstone of treatment for systemic manifestations, particularly in children 3, 4
• Close monitoring in an intensive care setting with:
  • Continuous cardiac monitoring
  • Vital sign assessment
  • Respiratory support if needed 3

Specific Medications for Severe Cases

• Prazosin (30 μg/kg/dose every 6 hours) for autonomic symptoms 5
• Dobutamine for cardiovascular support in cases of myocarditis or pulmonary edema 5

Special Considerations

Children

• Children are at higher risk for severe envenomation and require more aggressive treatment 3
• Mortality is higher in children who receive delayed treatment (>4 hours after sting) 5
• Avoid administering steroids and antihistamines as first-line treatments, as they have been associated with poorer outcomes 5

Regional Variations

• The severity of scorpion stings varies by geographic region and scorpion species
• Treatment protocols may vary based on local scorpion species 4

Pitfalls to Avoid

• Do not delay seeking medical attention if systemic symptoms develop, as early treatment significantly improves outcomes 3, 5
• Do not assume all scorpion stings are benign, especially in children or when stung by potentially dangerous species 3
• Avoid using antibiotics unless there is evidence of secondary infection, as the swelling is caused by mediator release, not infection 2
• Do not administer steroids or antihistamines as first-line treatment for scorpion stings, as they may worsen outcomes 5

Following this evidence-based approach to scorpion sting management can significantly reduce morbidity and mortality, particularly in vulnerable populations such as children.