What is the treatment for a scorpion bite?

Treatment of Scorpion Bites

The management of scorpion envenomation requires immediate medical attention, with treatment focused on supportive care, cardiac monitoring, and administration of specific antivenom for severe cases. 1, 2

Initial Assessment and First Aid

• Activate emergency services immediately for any person bitten by a venomous or potentially venomous scorpion 3, 1
• Clean the wound with soap and water 1
• Apply ice (with a barrier) for pain relief 1
• Remove rings and other constricting objects from the affected extremity 3
• Rest and immobilize the bitten extremity to minimize venom spread 3
• Use over-the-counter pain medications such as acetaminophen or NSAIDs (ibuprofen, naproxen) for mild pain 1

Clinical Manifestations to Monitor

Scorpion envenomation severity varies widely based on:

• Scorpion species (most venomous: Buthotus tamulus, Leiurus quinquestriatus, Androctonus crassicauda, Tityus serrulatus, Centruroides suffussus) 2
• Patient age (more severe in children) 2, 4
• Time to treatment (longer delays associated with worse outcomes) 4

Symptoms to monitor:

• Local symptoms: Pain, paresthesia, erythema, edema 2, 5
• Systemic symptoms (requiring urgent intervention): 2, 6
  • Cardiovascular: Tachycardia, hypertension (early), hypotension (late), arrhythmias, cardiac failure
  • Neurological: Agitation, muscle rigidity, tremor, seizures, altered consciousness
  • Respiratory: Shortness of breath, pulmonary edema
  • Other: Vomiting, abdominal pain, excessive salivation, diaphoresis

Hospital-Based Management

Monitoring and Supportive Care

• Continuous cardiac monitoring 2, 4
• Secure airway if altered consciousness (GCS <8) 1
• Intravenous fluid therapy 2, 7
• Regular monitoring of vital signs, blood glucose, and cardiac enzymes 2, 6
• ECG monitoring for ischemic changes 2, 6

Pharmacological Management

1. Pain management:

   • Intravenous opioids (e.g., meperidine) for severe pain 5

2. Cardiovascular management: 2, 6

   • Hypertensive phase: Vasodilators, adrenergic antagonists, or calcium channel blockers
   • Hypotensive phase: Inotropic agents and vasopressors (e.g., norepinephrine)
   • Antiarrhythmics (e.g., lidocaine) as needed

3. Antivenom therapy: 2, 7, 4

   • Indicated for severe envenomation with systemic symptoms
   • Must be specific to the scorpion species
   • May require multiple doses in severe cases
   • Administered intravenously, diluted in saline

Special Considerations

• Children require closer monitoring due to higher risk of severe reactions 4
• Patients with delayed presentation (>2 hours) have higher risk of severe symptoms 7, 4
• Intensive care unit admission recommended for patients with systemic symptoms 4

Common Pitfalls to Avoid

• Do not apply:

  • Suction to the bite site 3, 1
  • Direct pressure immobilization bandages 1
  • Tourniquets (except temporarily for severe bleeding) 3, 1
  • Electric shock 3
  • Ice directly to skin without a barrier 1
  • Folk remedies (e.g., alcohol and salt are ineffective) 5

• Do not delay seeking medical attention - longer time to treatment correlates with worse outcomes 4

• Do not forget to identify the scorpion if possible (safely capture or photograph for species identification) to guide antivenom selection 7