Scorpion envenomation: Difference between revisions
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== Background == | == Background == | ||
[[File:Bbasgen-bark-scorpion.jpg|thumb|Arizona Bark Scorpion, (''Centruroides sculpturatus'')]] | [[File:Bbasgen-bark-scorpion.jpg|thumb|Arizona Bark Scorpion, (''Centruroides sculpturatus'')]] | ||
*Most scorpion stings in North America result only in local pain. | |||
*Arizona Bark Scorpion, ''Centruroides sculpturatus'', found in AZ, NM, TX, and CA, can cause systemic toxicity. | |||
==Clinical Features== | ==Clinical Features== | ||
| Line 27: | Line 27: | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Bites and stings DDX}} | {{Bites and stings DDX}} | ||
==Diagnosis== | |||
*Usually clinical | |||
==Treatment== | ==Treatment== | ||
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#*Serious side effects: anaphylaxis | #*Serious side effects: anaphylaxis | ||
#*Costs approx $8000 over vial, needing 3-4 vials for treatment<ref>http://www.azcentral.com/news/articles/2011/11/10/20111110scorpion-drug-cost.html</ref> | #*Costs approx $8000 over vial, needing 3-4 vials for treatment<ref>http://www.azcentral.com/news/articles/2011/11/10/20111110scorpion-drug-cost.html</ref> | ||
==Disposition== | |||
==See Also== | ==See Also== | ||
*[[Bites and Stings]] | *[[Bites and Stings]] | ||
== | == References == | ||
<references/> | <references/> | ||
[[Category:Environ]] | [[Category:Environ]] | ||
[[Category:Derm]] | [[Category:Derm]] | ||
Revision as of 18:23, 9 June 2015
Background
- Most scorpion stings in North America result only in local pain.
- Arizona Bark Scorpion, Centruroides sculpturatus, found in AZ, NM, TX, and CA, can cause systemic toxicity.
Clinical Features
Local reaction
- Immediate and severe pain
- "Tap" test: severe local tenderness when affected area is lightly tapped
Systemic reaction
- Uncommon but can be severe, particularly in children
- Cranial nerve and somatic motor dysfunction can develop:
- Abnormal roving eye movements (pathognomonic) , blurred vision, pharyngeal muscle incoordination
- Can occasionally lead to respiratory compromise (excessive secretion)
- Tachycardia and severe agitation can also be present
- Without antivenom, symptoms typically last 24-48 hrs
Grades of Centruroides envenomation
- Grade 1 - Local pain and/or paresthesias at site of envenomation
- Grade 2 - Pain and/or paresthesias remote from the site of the sting, in addition to local findings
- Grade 3 - Either cranial nerve/autonomic dysfunction or somatic skeletal neuromuscular dysfunction
- Cranial nerve dysfunction - Blurred vision, roving eye movements, hypersalivation, tongue fasciculations, dysphagia, dysphonia, problems with upper airway
- Somatic skeletal neuromuscular dysfunction - Restlessness, severe involuntary shaking or jerking of the extremities that may be mistaken for a seizure
- Grade 4 - Combined cranial nerve/autonomic dysfunction and somatic nerve dysfunction
Differential Diagnosis
Envenomations, bites and stings
- Hymenoptera stings (bees, wasps, ants)
- Mammalian bites
- Closed fist infection (Fight bite)
- Dog bite
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
- Scorpion envenomation
- Reptile envenomation
- Spider bites
Diagnosis
- Usually clinical
Treatment
- Apply ice to area of sting
- Atropine
- May be given for hypersalivation and respiratory distress caused
- Contraindicated for foreign scorpion stings because may exacerbate adrenergic effects
- May be given for hypersalivation and respiratory distress caused
- Anascorp Antivenom[1] - Only available in Arizona, Nevada, and Utah