Scorpion envenomation - Revision history

Elcatracho: /* Management */

2020-11-26T01:03:50Z

Management

← Older revision		Revision as of 01:03, 26 November 2020
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	**May be given for hypersalivation and respiratory distress caused		**May be given for hypersalivation and respiratory distress caused
	**Contraindicated for scorpion stings not indigenous to US (may exacerbate adrenergic effects)		**Contraindicated for scorpion stings not indigenous to US (may exacerbate adrenergic effects)
			**Alternatively, can administer [[glycopyrrolate]]
	*Anascorp antivenom (Centruroides immune Fab) - Only stocked by certain hospitals in Arizona, Nevada, and Utah<ref>http://www.anascorp-us.com/hospital/ Accessed 08/03/15</ref>		*Anascorp antivenom (Centruroides immune Fab) - Only stocked by certain hospitals in Arizona, Nevada, and Utah<ref>http://www.anascorp-us.com/hospital/ Accessed 08/03/15</ref>
	**Resolves clinical syndrome within 4hr<ref>http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm266515.htm</ref><ref name="Boyer">Boyer LV, Theodorou AA, Berg RA, Arizona Envenomation investigators, et al. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med. 2009 May 14;360(20):2090-8.</ref>		**Resolves clinical syndrome within 4hr<ref>http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm266515.htm</ref><ref name="Boyer">Boyer LV, Theodorou AA, Berg RA, Arizona Envenomation investigators, et al. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med. 2009 May 14;360(20):2090-8.</ref>

Rossdonaldson1: /* Clinical Features */

2020-07-18T13:41:48Z

Clinical Features

← Older revision		Revision as of 13:41, 18 July 2020
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	==Clinical Features==		==Clinical Features==
			[[File:PMC4395898 40409 2014 85 Fig2 HTML.png\|thumb\|Local scorpion sting (''Rhopalurus amazonicus Lourenço'', Brazil).]]

	===Local reaction===		===Local reaction===
	*Pain and [[paresthesias]] near envenomation site.		*Pain and [[paresthesias]] near envenomation site.

SuperD: /* Evaluation */

2020-01-25T09:27:01Z

Evaluation

← Older revision		Revision as of 09:27, 25 January 2020
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	==Evaluation==		==Evaluation==
	*Generally clinical diagnosis		*Generally clinical diagnosis
	**Be aware that a discrete scorpion ~~bite~~ mark may not be clinically apparent.		**Be aware that a discrete scorpion sting mark may not be clinically apparent.

	==Management==		==Management==

ClaireLewis at 21:45, 28 September 2019

2019-09-28T21:45:05Z

← Older revision		Revision as of 21:45, 28 September 2019
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	*Supportive care		*Supportive care
	**Cold compress to area of sting		**Cold compress to area of sting
	**Analgesic and anti-inflammatory medications		**[[analgesia\|Analgesic]] and anti-inflammatory medications
	**[[Benzodiazepines]] may help with agitation and muscle spasm		**[[Benzodiazepines]] may help with agitation and muscle spasm
	**Intubation for pulmonary symptoms is rare, but may be necessary		**Intubation for pulmonary symptoms is rare, but may be necessary

ClaireLewis at 17:12, 26 August 2019

2019-08-26T17:12:14Z

← Older revision		Revision as of 17:12, 26 August 2019
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	==Clinical Features==		==Clinical Features==
	===Local reaction===		===Local reaction===
	*Pain and paresthesias near envenomation site.		*Pain and [[paresthesias]] near envenomation site.
	**"Tap" test: severe local tenderness when affected area is lightly tapped		**"Tap" test: severe local tenderness when affected area is lightly tapped

	===Systemic reaction===		===Systemic reaction===
	*Uncommon but can be severe, particularly in children		*Uncommon but can be severe, particularly in children
	*Cranial nerve and somatic motor dysfunction can develop:		*[[Cranial nerve palsies]] and [[weakness\|somatic motor dysfunction]] can develop:
	**Abnormal roving eye movements, blurred vision, pharyngeal muscle incoordination		**Abnormal roving eye movements, blurred vision, pharyngeal muscle incoordination
	**Hypersalivation, noncardiac pulmonary edema (can → respiratory distress/failure)
	**Tongue fasciculations and uncoordinated motor agitation (flailing or jerking extremities)		**Tongue fasciculations and uncoordinated motor agitation (flailing or jerking extremities)
	*Tachycardia, other dysautonomias, and severe agitation can also be present		*Hypersalivation, noncardiac [[pulmonary edema]]
			**can → [[respiratory distress]]/failure
			*[[Tachycardia]], other dysautonomias, and severe agitation can also be present
	*Without antivenom, symptoms typically last 24-48 hrs		*Without antivenom, symptoms typically last 24-48 hrs

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	**Cold compress to area of sting		**Cold compress to area of sting
	**Analgesic and anti-inflammatory medications		**Analgesic and anti-inflammatory medications
	**Benzodiazepines may help with agitation and muscle spasm		**[[Benzodiazepines]] may help with agitation and muscle spasm
	**Intubation for pulmonary symptoms is rare, but may be necessary		**Intubation for pulmonary symptoms is rare, but may be necessary
	*[[Atropine]]		*[[Atropine]]

Kxl328: /* Management */

2018-11-09T13:24:44Z

Management

← Older revision		Revision as of 13:24, 9 November 2018
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	**Analgesic and anti-inflammatory medications		**Analgesic and anti-inflammatory medications
	**Benzodiazepines may help with agitation and muscle spasm		**Benzodiazepines may help with agitation and muscle spasm
			**Intubation for pulmonary symptoms is rare, but may be necessary
	*[[Atropine]]		*[[Atropine]]
	**May be given for hypersalivation and respiratory distress caused		**May be given for hypersalivation and respiratory distress caused

Rossdonaldson1: Text replacement - "approx " to "approximately "

2016-08-01T17:43:09Z

Text replacement - "approx " to "approximately "

← Older revision		Revision as of 17:43, 1 August 2016
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	**Common side effects: vomiting, pyrexia, rash, nausea, and pruritus		**Common side effects: vomiting, pyrexia, rash, nausea, and pruritus
	**Serious side effects: anaphylaxis		**Serious side effects: anaphylaxis
	**Costs ~~approx~~ $8000 per vial, and requires 3-4 vials for treatment<ref>http://www.azcentral.com/news/articles/2011/11/10/20111110scorpion-drug-cost.html</ref>		**Costs approximately $8000 per vial, and requires 3-4 vials for treatment<ref>http://www.azcentral.com/news/articles/2011/11/10/20111110scorpion-drug-cost.html</ref>

	==Disposition==		==Disposition==

Neil.m.young: Text replacement - "==Diagnosis==" to "==Evaluation=="

2016-07-26T04:21:28Z

Text replacement - "==Diagnosis==" to "==Evaluation=="

← Older revision		Revision as of 04:21, 26 July 2016
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	{{Bites and stings DDX}}		{{Bites and stings DDX}}

	==~~Diagnosis~~==		==Evaluation==
	*Generally clinical diagnosis		*Generally clinical diagnosis
	**Be aware that a discrete scorpion bite mark may not be clinically apparent.		**Be aware that a discrete scorpion bite mark may not be clinically apparent.

Neil.m.young: Text replacement - "* " to "*"

2016-07-09T08:42:51Z

Text replacement - "* " to "*"

← Older revision		Revision as of 08:42, 9 July 2016
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	===Local reaction===		===Local reaction===
	*Pain and paresthesias near envenomation site.		*Pain and paresthesias near envenomation site.
	** "Tap" test: severe local tenderness when affected area is lightly tapped		**"Tap" test: severe local tenderness when affected area is lightly tapped

	===Systemic reaction===		===Systemic reaction===

Mholtz at 23:51, 3 April 2016

2016-04-03T23:51:28Z

← Older revision		Revision as of 23:51, 3 April 2016
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	==Background==		==Background==
	*Most scorpion stings in North America result only in local pain.		*Most scorpion stings in North America result only in local pain.
	*Arizona Bark Scorpion, ''Centruroides sculpturatus'', found in AZ, NV, NM, TX, and CA, is the only neurotoxic species found in North America and can cause systemic toxicity.<ref name="Boyer" />		*Arizona Bark Scorpion (''Centruroides sculpturatus''), found in AZ, NV, NM, TX, and CA, is the only neurotoxic species found in North America and can cause systemic toxicity.<ref name="Boyer" />

	[[File:Bbasgen-bark-scorpion.jpg\|thumb\|Arizona Bark Scorpion, (''Centruroides sculpturatus'')]]		[[File:Bbasgen-bark-scorpion.jpg\|thumb\|Arizona Bark Scorpion, (''Centruroides sculpturatus'')]]

	===Pathophysiology===		===Pathophysiology===
	Four neurotoxins~~, designated~~ toxins I to IV, have been isolated from ''C. exilicauda''~~. These toxins~~ target excitable membranes especially at the neuromuscular junction, by opening sodium channels~~. This results in~~ repetitive depolarization of nerves in both sympathetic and parasympathetic nervous systems ~~causing~~ catecholamine and acetylcholine release.<ref>Nelson, Lewis, and Lewis R. Goldfrank. Goldfrank's Toxicologic Emergencies. New York: McGraw-Hill Medical Division, 2014. Print.</ref>		*Four neurotoxins (toxins I to IV) have been isolated from ''C. exilicauda''
			*Toxins target excitable membranes, especially at the neuromuscular junction, by opening sodium channels → repetitive depolarization of nerves in both sympathetic and parasympathetic nervous systems → catecholamine and acetylcholine release.<ref>Nelson, Lewis, and Lewis R. Goldfrank. Goldfrank's Toxicologic Emergencies. New York: McGraw-Hill Medical Division, 2014. Print.</ref>

	==Clinical Features==		==Clinical Features==