INTRODUCTION

Scorpions are a member of the Arachnida class and are closely related to spiders, ticks,
and mites. Scorpions have two pincers, 8 legs and an elongated body with a tail composed of
segments; they range in length from about 9 to 21 cm. Some species are smaller, more
translucent, and harder to see. They may appear as a thin string on the ground. The last tail
segment contains the stinger (also termed a telson) that transmits a toxin to the recipient of a
sting. Most scorpions are harmless. Although about 2000 species exist, only about 25-40 species
can deliver enough venom to cause serious or lethal damage to humans. One of the more
venomous or potentially dangerous species, especially for infants, young children, and the
elderly in the United States is Centruroides exilicauda or bark scorpion. Contact with scorpions
is usually accidental. Scorpion stings are painful, and they can be fatal, particularly to children.
Scorpions may sting more than once; the stinger, located at the end of the tail segment is usually
not lost or left in the person's tissue after a sting.

Scorpions come in a variety of colors - from tan to light brown to black. Each has a long
tail segment that contains a stinger. Scorpions are found in highest numbers across the southern
United States and in arid or desert regions in most other countries. However, they can be found
occasionally in most US states and in temperate regions of both South America and Africa and
some even reside in cold climates. Scorpions hunt at night and hide along rocks or trees during
the days. Homes built in arid or desert regions commonly have scorpions in them

CLINICAL MANIFESTATION
In general, the sting usually causes discomfort that slowly decreases over time. The
discomfort, described below, usually ranges from moderate to severe. A person who has been
stung by a scorpion may feel a painful, tingling, burning or numbing sensation at the sting site.
The reaction at the sting site may appear mild. Rarely, a person experiencing a serious reaction
may develop severe symptoms throughout the body.
Severe symptoms include
 widespread numbness,  seizures,
 difficulty swallowing,  salivation, and
 a thick tongue,  difficulty breathing.
 blurred vision,
 roving eye movements,
Symptoms and signs of increased sympathetic activity include hypertension, tachycardia,
cardiac dysrhythmias, increased perspiration, fever, hyperglycemia and restlessness. An
increase in catecholamine levels has been demonstrated in severe envenoming’s. Hypertension
may also be induced by an increase in renin release. Parasympathetic effects include increased
salivation, bradycardia, hypotension and gastric distension. Tremors and involuntary
movements seen in scorpionism are due to excessive somatic neuromuscular activity. Muscle
weakness, difficulty in breathing and bulbar paralysis could be explained by a phase of relative
neurotransmitter depletion after excessive neuronal activity with regard to the mechanism of
action of neurotoxic venoms on the peripheral nervous system.
LABORATORY DIAGNOSIS
Scorpion venom is injected by means of a stinger located at the tip of the telson, the
terminal segment of the ‘tail’. The bulbous portion of the telson, also known as the vesicle,
contains two venom glands, each with a duct opening on each side near the tip of the stinger.
During the stinging process, muscles attached to the exoskeleton on each side of the gland
contract, injecting the venom through the orifices
The clinical profile of scorpionism primarily reflects a state of generalized neurological
hyperexcitability. Other excitable tissue, such as skeletal and heart muscle, may also be
affected. Scorpion venoms are complex aqueous mixtures containing mucus, inorganic salts,
low-molecular-weight organic molecules and many different small basic proteins (Mr 8000),
which are the neurotoxins. The neurotoxins act on sodium channels of excitable cells, either by
retarding inactivation (an α-toxin) or enhancing activation (a ß-toxin) leading to spontaneous
depolarisation of excitable cells. The overall effect is a tendency of the neuron to fire
spontaneously and repetitively. Noradrenaline and acetylcholine are released from adrenergic
and cholinergic nerve endings, respectively, and adrenaline is released from the adrenal
medulla. These mechanisms may explain the sympathetic, para-sympathetic and skeletal muscle
effects of scorpion venom.
Diagnosis and clinical profile of scorpionism
The spectrum and degree of symptoms and signs of systemic envenoming are determined by
several factors:
• the scorpion species involved
• the body mass of the victim (children are more vulnerable than adults)
• the amount of venom injected
• the physical health of the patient.
The clinical presentation of scorpionism in the under-13-year-old age group differs in many
respects from that in the older patient (>13 years).
Scorpion envenomation cases vary from those requiring no laboratory tests to scenarios
requiring extensive hematologic, electrolyte, and respiratory analysis. Obtain a CBC count,
as Hemiscorpius lepturus has been shown to cause severe hemolysis. In addition, marked
leukocytosis suggests induction of a venom-mediated systemic inflammatory response‒like
syndrome. Electrolyte evaluation is warranted in patients with venom-induced salivation,
vomiting, and diarrhea. Coagulation parameters should be measured for venom-induced
defibrination because, at high concentrations, the venom is an anticoagulant. Defibrination
syndrome has been reported following Mesobuthus tamulus stings. Glucose levels should be
measured to evaluate for hyperglycemia from liver and pancreas dysfunction. Troponin and NT-
proBNP elevation suggests myocarditis. Creatine kinase and urinalysis help evaluate for venom-
induced excessive motor rhabdomyolysis. Renal failure may occur secondary to hemoglobinuria
from hemolysis (after H lepturus sting) or myoglobinuria from rhabdomyolysis
Obtain amylase/lipase values to assess for pancreatitis, which is common, from Tityus
trinitatis stings.
 Patients may have increased aspartate aminotransferase and alanine aminotransferase
levels from venom-induced liver cell destruction.
Increased catecholamine, aldosterone, renin angiotensin, and antidiuretic hormone levels are
detected a few hours after the sting. The increased levels persist for 6 hours, after which a
gradual decline occurs.
Obtain arterial blood gas (ABG) measurements as indicated for respiratory distress or to
determine acid/base status. Additional laboratory abnormalities that may have research relevance
include interleukin (IL)–1 levels, which have been reported to be elevated.High levels of IL-6,
interferon-gamma, and granulocyte-macrophage colony-stimulating factor are reported in severe
envenomations. Radiolabeled antibodies or immunoenzymatic assays help quantify the serum
venom level because an association exists between the clinical signs of envenomation and this
level. [25] However, it is rarely used, owing to cost and because clinical grading is as effective. It
is most likely only used as a research tool.

MANAGEMENT
Most stings only require supportive therapy including ibuprofen, cleaning of the sting area, and
tetanus prophylaxis. Patients should be observed for at least 4 hours, but the onset of life-
threatening symptoms occurs much quicker in children, with an average of 14 minutes. In most
scorpion stings of adults, treatment is simply supportive and can be done at home.
 Wash the sting with soap and water and remove all jewelry because swelling of tissue
may impede the circulation if it not allowed to expand (for example, a sting on a finger
that has a ring surrounding it).
 Apply cool compresses, usually 10 minutes on and ten minutes off of the site of the sting.
 Acetaminophen (Tylenol) 1-2 tablets every 4 hours may be given to relieve pain(usually not to
exceed 3g per 24 hours). Avoid aspirin and ibuprofen (Advil,Motrin) because they may
contribute to other problems.
 Antibiotics are not helpful unless the sting area become secondarily infected.
 Do not cut into the wound or apply suction.
 If a child is 5 years or younger is stung, seek evaluation by a medical caregiver.
 If symptoms increase in severity, go to an Emergency Department.
In patients with severe envenomation displaying symptoms such as hypersalivation,
clonus, rapid eye movements, or restlessness, immediate intervention is critical. These patients
may need endotracheal intubation due to the possibility of rapid onset severe pulmonary edema.
As cardiogenic shock can complicate this, administration of dobutamine has been shown to be
helpful. Intravenous benzodiazepines may be used if the patient displays muscle spasticity.
Antivenom is reserved for patients displaying skeletal muscle or cranial nerve dysfunction who
are stung by Centruroides scorpions. It is available in the United States, under the name
Anascorp, which is intravenous scorpion-specific F(ab’)2 equine antivenom. It has been shown
to reduce the duration of clinical symptoms if given within 4 hours of the sting. The
recommended dose is three vials, followed by an additional two if symptoms continue.
Complications are low and comprise mostly serum sickness (0.5%). Anascorp is considered
much safer than the previous antivenom, which was marketed in 1965 and taken off shelves in
2001 due to its high rates of anaphylaxis (3.4%). No cases of anaphylaxis have been reported in
patients administered Anascorp. Although effective, Anascorp can be quite expensive, with some
hospitals charging upward of $40,000 per vial. If a patient is observed for 4 hours and is
determined to have a mild sting, is tolerating oral intake, and has adequate pain control, the
patient may be safely discharged home with return precautions.
In cases where the scorpion has not been identified, it is recommended that the
asymptomatic child be admitted to a medical facility for observation for at least 12 hours.
Scorpion antivenom should be given to all patients with symptoms and signs of systemic
envenoming. The scorpion antivenom (SAIMR Scorpion Venom Antiserum SAVP) is a refined
equine anti-scorpion serum globulin supplied in 5 ml ampoules. The standard dose is 5 - 10 ml
intravenously for both adults and children. It usually takes 2 - 6 hours to reach its peak effect and
therefore respiratory support is life-saving in the interim period. Occasionally an additional dose
of 5 ml may be administered after 6 hours should the response to the first dose be inadequate.
Allergic/anaphylactoid reactions to the antivenom may develop, as is the case with all serum
preparations of animal origin. The prophylactic administration of adrenaline intramuscularly to
prevent serious allergic reactions is controversial because it may increase the effects of
sympathetic nervous system stimulation by the scorpion venom. The victim should be kept under
observation for 6 - 12 hours after antivenom administration.
Special investigations which may assist in assessment and treatment include: pH and
electrolytes, acid-base balance, arterial blood gasses and an ECG where applicable.
CONCLUSION
Therefore, scorpion bite or sting can be life-threatening, especially in infants and
children." It can manisfestate mild to severe symptoms depending on what type of scorpion and
amount of venom been injected. Any individual been bitten should seek medical care
immediately to prevent severe manifestation to occur and call your local poison control center.

REFERENCE
 https://www.emedicinehealth.com/wilderness_scorpion_sting/article_em.htm#what_are_t
he_symptoms_of_a_scorpion_sting
 http://www.cmej.org.za/index.php/cmej/article/view/2545/2580
 http://nursing-procedure.blogspot.com/2012/09/scorpion-sting.html
 https://www.emedicinehealth.com/wilderness_scorpion_sting/article_em.htm#when_to_s
eek_medical_care_for_a_scorpion_sting