Mwandishi:
ULY CLINIC
Mhariri:
ULY CLINIC
Imeboreshwa:
20 Oktoba 2026, 15:33:02
Scorpion Sting (Envenoming) Management
Scorpion stings cause severe local pain and can cause systemic toxicity. Children are at higher risk of severe envenoming and death than adults.
Clinical presentation
Local: severe pain and paraesthesia at or near the sting site.
Neurological: distant paraesthesia, blurred vision, nystagmus or roving eyes, tongue fasciculations, difficulty swallowing or speaking, restlessness, tremors, jerking, tetanus-like rigidity.
Autonomic: fast or slow heart rate, high or low blood pressure, excess salivation and tears, incontinence, sweating.
Severe: pulmonary oedema, cardiogenic shock, hyperthermia, rhabdomyolysis, multi-organ failure, death.
Grading of scorpion envenoming
Grade | Clinical features |
I | Local pain with or without mild paraesthesia at the sting site |
II | Local pain and paraesthesia extending above the sting site |
III | Cranial nerve involvement (salivation, visual disturbance, nystagmus) and/or neuromuscular dysfunction (tremors, spasms, abnormal posture), with or without autonomic dysfunction |
IV | Severe systemic toxicity: pulmonary oedema, rhabdomyolysis, hyperthermia, cardiogenic shock, multi-organ failure |
Non-pharmacological management
Airway, breathing, circulation and oxygen.
Keep the patient calm to reduce sympathetic stimulation.
Continuous monitoring of oxygen saturation, heart rate, respiratory rate and blood pressure.
Recognise and treat pulmonary oedema or shock early.
Pharmacological management
Indication | Management |
Local wound care | Clean the sting site with normal saline |
Fluids | A: Ringer's lactate IV as maintenance or resuscitation, according to clinical status |
Pain and mild systemic symptoms | A: Paracetamol (PO/IV) adults 1 g every 8 hours for 48 hours, children 15 mg/kg every 8 hours; OR A: ibuprofen adults 400–800 mg every 8 hours for 3 days, children 10 mg/kg every 8 hours (maximum 400 mg/day) |
Severe local pain | A: Lidocaine 1% infiltration at the sting site |
Severe pain (rescue) | C: Morphine IV/IM titrated to severity |
Grade III–IV envenoming | A: Scorpion antivenom immunoglobulin IV in 20–50 ml normal saline: first 1 vial over 10 minutes and observe for 60 minutes; repeat at 30-minute intervals if symptoms persist, up to 3 vials in total |
Anaphylaxis to antivenom | A: Epinephrine IM according to the anaphylaxis protocol |
Severe cardiovascular or respiratory compromise | Prepare for airway support, intubation and intensive care |