Scorpion Stings

Epidemiology: Only ∼30 of the ∼1000 species of scorpions produce potentially lethal venoms, causing >5000 deaths worldwide each year. Among scorpions in the United States, only the bark scorpion (Centruroides sculpturatus or C. exilicauda) in the Southwest produces a potentially lethal venom.
Clinical features: The severity of symptoms depends on the particular scorpion species. For the U.S. bark scorpion, symptoms progress to maximal severity in ∼5 h and typically subside within 1-2 days, although pain and paresthesias can last for weeks.
- Bark scorpion: Swelling generally is not apparent; tapping on the affected area (the tap test) can accentuate pain, paresthesia, and hyperesthesia. Cranial nerve dysfunction and skeletal muscle hyperexcitability develop within hours. Complications include tachycardia, arrhythmias, hypertension, hyperthermia, rhabdomyolysis, acidosis, and occasional fatal respiratory arrests.
- Outside the United States, scorpion envenomations can cause massive release of endogenous catecholamines with hypertensive crises, arrhythmias, pulmonary edema, and myocardial damage.

TREATMENT
Scorpion Stings Stings of nonlethal species require at most ice packs, analgesics, or antihistamines. In severe envenomations, aggressive supportive care should include pressure dressings and cold packs to decrease the absorption of venom. A continuous IV infusion of midazolam helps control agitation and involuntary muscle movements. C. sculpturatus antivenom administered IV rapidly reverses cranial nerve dysfunction and muscular symptoms.