The sting of the scorpion causes discomfort (moderate to severe), which reduces over a period of time. Discomfort is often described as a painful or burning sensation at the site of the sting. Severe reactions of the sting such as difficulty in swallowing, blurred vision, seizures, uncontrolled eye-movements, thick tongue and breathing problems, often considered a medical emergency, are observed. Deaths due to scorpion sting have also been reported [5] [6] [7].

• Localized Pain

  The patient felt a severe sharp local pain that did not improve until he presented to the hospital 12 hours later. Block of the dorsal nerves of the penis with 1% lidocaine led to immediate relief of the pain. [ncbi.nlm.nih.gov]

  Edema Nausea and vomiting Hyperthermia Respiratory failure Erythema Urticaria Sweating Dysgeusia Grades of Scorpion Envenomation Grade I: Local pain and/or paresthesias Grade II: Local and remote pain and/or paresthesias Grade III: Local pain with paresthesias [lasvegasemr.com]

  The stings usually cause only localized pain with minimal swelling, some lymphangitis with regional lymphadenopathy, increased skin temperature, and tenderness around the wound. [msdmanuals.com]

  The remaining 40 patients had severe local pain only and no subsequent cardiac manifestations. [thelancet.com]

• Fever

  Plot Synopsis Tigress has River Fever and it's up to Po and Monkey to bring back the cure. [kungfupanda.wikia.com]

  We describe a 13-year-old girl who, following envenoming by a scorpion, developed recurrent attacks of sharp, intermittent pain in the umbilical region associated with fever, nausea, anorexia and vomiting, and changes in her psychological behaviour. [ncbi.nlm.nih.gov]

  Adverse events related to treatment included vomiting, fever, rash, nausea, itchiness, headache, runny nose, and muscle pain. Patients hypersensitive to horse proteins may have an early or delayed reaction to the antidote. [medpagetoday.com]

• Recurrent Infection

  Both patients completed a 6-week postoperative course of antibiotic therapy and are without recurrent infection. [ncbi.nlm.nih.gov]

• Dyspnea

  On admission, the main clinical manifestations were: dyspnea, tachypnea, and tachycardia. Chest x-ray revealed APE predominantly on the right hemithorax. [ncbi.nlm.nih.gov]

  Initial pain is followed within several hours by numbness, nausea, muscle spasm, dyspnea, and convulsion. Anascorp, an antivenin, was approved for use in the United States in 2011. The antivenin has been available in Mexico for many years. [medical-dictionary.thefreedictionary.com]

  Browse recently published Learning/CME Learning/CME View all learning/CME CME A Trial of a Shorter Regimen for Rifampin-Resistant Tuberculosis Case 10-2019: A 69-Year-Old Man with Progressive Dyspnea Mucinous Ovarian Carcinoma Challenge Yourself Interactive [nejm.org]

  They stated that the patients showed clinical symptoms like abdominal pain, muscle contractions, nausea, hypertension, hypotension, bradycardia, dyspnea, pulmonary edema, convulsion, and shock and reported 8.3% lethality due to cardio and respiratory [scielo.br]

• Vomiting

  Important clinical features recorded were circulatory failure, breathlessness, profuse sweating, vomiting, local oedema and convulsion. Incidences of scorpion stings were much more frequent in the summer and rainy seasons than in the winter season. [ncbi.nlm.nih.gov]

  Signs and symptoms resemble the bee sting such as hives, difficulty in breathing, nausea and vomiting. Scorpion sting appears as a barb that contains the protein toxin. [symptoma.com]

  Experts said allergy to scorpions is actually extremely rare, and signs include hives, swelling, asthma symptoms, nausea, and vomiting. There is no update on the little girl's condition, as of Thursday evening. [fox10phoenix.com]

• Nausea

  We describe a 13-year-old girl who, following envenoming by a scorpion, developed recurrent attacks of sharp, intermittent pain in the umbilical region associated with fever, nausea, anorexia and vomiting, and changes in her psychological behaviour. [ncbi.nlm.nih.gov]

  Experts said allergy to scorpions is actually extremely rare, and signs include hives, swelling, asthma symptoms, nausea, and vomiting. There is no update on the little girl's condition, as of Thursday evening. [fox10phoenix.com]

  Signs and symptoms resemble the bee sting such as hives, difficulty in breathing, nausea and vomiting. Scorpion sting appears as a barb that contains the protein toxin. [symptoma.com]

  Symptoms in these cases are similar to those of anaphylaxis caused by bee stings and can include trouble breathing, hives, nausea, and vomiting. Older adults and children are the most likely to die from an untreated venomous scorpion bite. [healthline.com]

• Abdominal Pain

  Chronic relapsing pancreatitis is a rare cause of abdominal pain in children and exceptionally rarely is related to a scorpion sting. [ncbi.nlm.nih.gov]

  In some rare cases, pancreatitis – a painful inflammation of the pancreas – may occur. Some symptoms of pancreatitis are abdominal pain, chills, fever, sweating, and nausea. [boyslife.org]

• Abdominal Cramps

  Serious symptoms start within minutes of the sting and may include: Increased salivation (foaming at the mouth or drooling) Blurred vision Trouble focusing Slurred speech Muscle twitches Abdominal cramps Seizures Trouble breathing If you see any of these [thesurvivaldoctor.com]

  cramps Inability to hold in stool Nausea and vomiting Most stings from North American scorpions do not need treatment. [nlm.nih.gov]

• Hypertension

  Stroke following scorpion sting is a rare complication and can occur by various mechanisms such as hypertension, hypotension, DIC, myocarditis and venom-induced vasculitis. [ncbi.nlm.nih.gov]

  For serious stings by scorpions not native to North America, prazosin may help prevent pulmonary edema due to extreme hypertension, and opioids may be indicated for pain control. [merckmanuals.com]

• Tachycardia

  After admission, the patient had four cardiac arrests (three episodes of pulseless ventricular tachycardia/ventricular fibrillation and one episode of asystole) over the next few hours. [ncbi.nlm.nih.gov]

  Tachycardia, hypotension with or without pulmonary oedema with warm extremities (warm shock). [slideshare.net]

• Hypotension

  Stroke following scorpion sting is a rare complication and can occur by various mechanisms such as hypertension, hypotension, DIC, myocarditis and venom-induced vasculitis. [ncbi.nlm.nih.gov]

• Refractory Shock

  Three cases developed anaphylactic shock as a consequence of scorpion antivenin administration, while 1 scorpion antivenin-untreated patient died from refractory shock. [ncbi.nlm.nih.gov]

• Foaming at the Mouth

  Joshua Strommen, highlighted the similarities between the symptoms of a scorpion bite, including movement disorder, movement of upper and lower extremities, and some foaming at the mouth, and symptoms of methamphetamine exposure. [medicaldaily.com]

  Serious symptoms start within minutes of the sting and may include: Increased salivation (foaming at the mouth or drooling) Blurred vision Trouble focusing Slurred speech Muscle twitches Abdominal cramps Seizures Trouble breathing If you see any of these [thesurvivaldoctor.com]

  "These [symptoms] include some movement disorders, and movement of upper and lower extremities, and some foaming at the mouth," Shirazi told Live Science. [ 6 Strange Meth Facts ] When the girl arrived at the emergency department of a hospital in Tucson [livescience.com]

  Foaming of the mouth, drooling, and vomiting. Muscles twitching and abnormal eye and neck movements. Difficulty breathing, talking, or swallowing. Severe swelling. Unintentional urination. [woundcaresociety.org]

  Seek medical attention immediately if you see any of the following symptoms. [5] [6] Vomiting, sweating, drooling, or foaming at the mouth Involuntary urination or excretion (peeing or pooing) Thrashing or twitching muscles, including involuntary head [wikihow.com]

• Hypersalivation

  Airway support is important and patients may require ventilation due to hypersalivation and autonomic dysfunction. [cdemcurriculum.com]

  Administer intravenous fluids to help prevent hypovolemia from vomiting, diarrhea, sweating, hypersalivation, and insensible water loss from a tropical environment. [emedicine.medscape.com]

  Grade I III Any of the following: Somatic skeletal neuromuscular dysfunction Jerking of extremities Restlessness Severe involuntary shaking and jerking, which may be mistaken for seizures Cranial nerve dysfunction Blurred vision Wandering eye movement Hypersalivation [aliem.com]

• Sialorrhea

  Serious symptoms, most common among children, include Restlessness Muscle spasms Abnormal and random head, neck, and eye movements Anxiety and agitation Sialorrhea and diaphoresis In adults, tachycardia, hypertension, increased respirations, weakness, [msdmanuals.com]

• Muscle Twitch

  Common symptoms of a scorpion sting include: pain, tingling or burning sensation at the sting site malaise, sweating, nausea and vomiting salivating numbness muscle twitching abnormal neck, eye and head movements/twitching heart palpitations breathing [desertusa.com]

  The bark scorpion, which is common in this area, has venom that causes symptoms like fast breaths, high blood pressure, a racing heart, weakness, and muscle twitches. [webmd.com]

  Venomous scorpion stings occur most frequently in infants and children, and may cause shortness of breath, fluid buildup in the lungs, excess saliva, slurred speech, trouble swallowing, abnormal eye movements, muscle twitching, trouble walking, other [medpagetoday.com]

  Doctors may advise hospitalization, followed by bed rest, tranquilizers for muscle spasms and injections to regulate blood pressure, pain and anxiety. [apollohospitals.com]

• Muscle Cramp

  The systemic symptomatology is mainly due to the catecholaminergic release, leading to tachycardia, increased blood pressure, restlessness, muscle cramps, and fasciculation. [jamanetwork.com]

  The nervous system manifestations are infrequent and they include encephalopathy, seizures, restlessness, areflexia, psychosis, strokes and muscle cramps [ 31 ]. The first two neurological complications are invariably fatal in children [ 32 ]. [ckj.oxfordjournals.org]

• Myalgia

  C4 (Neoplasms) 腫瘍 Carcinogenesis 発癌 Intraocular Lymphoma 眼内リンパ腫 Prostatic Neoplasms, Castration-Resistant 去勢抵抗性前立腺腫瘍 Triple Negative Breast Neoplasms トリプルネガティブ乳房腫瘍 C5 (Musculoskeletal Diseases) 筋骨格系疾患 Myalgia 筋肉痛 Rickets, Hypophosphatemic 低リン血症性くる病 C6 [sisoken.la.coocan.jp]

• Blurred Vision

  The symptoms of a severe reaction can be numbness, trouble swallowing, blurred vision, trouble breathing, thick tongue, salivation, or seizures. [scorpionpictureguide.com]

  Each person reacts differently to the sting, and symptoms can vary from severe pain to blurred vision. "If you're concerned at all, talk to your local poison center. And if symptoms are severe, get help right away." [mayoclinic.org]

  Serious symptoms start within minutes of the sting and may include: Increased salivation (foaming at the mouth or drooling) Blurred vision Trouble focusing Slurred speech Muscle twitches Abdominal cramps Seizures Trouble breathing If you see any of these [thesurvivaldoctor.com]

  Severe reactions of the sting such as difficulty in swallowing, blurred vision, seizures, uncontrolled eye-movements, thick tongue and breathing problems, often considered a medical emergency, are observed. [symptoma.com]

  Severe symptoms include shortness of breath, fluid in the lungs, breathing problems, excess saliva, blurred vision, slurred speech, trouble swallowing, abnormal eye movements, muscle twitching, thrashing of the arms and legs, trouble walking, and other [fda.gov]

• Diplopia

  […] venom toxicity, and should be avoided; atropine is used to combat parasympathetic effects scorpion sting A toxic systemic response to scorpion venom Clinical SOB, opisthotonus, nasal and periorbital itching, dysphasia, drooling, gastric distension, diplopia [medical-dictionary.thefreedictionary.com]

• Seizure

  She was then taken to a hospital where she achieved suboptimal seizure control, with daily tonic-clonic seizures during the following week. During this period, and between the seizures, she stayed alert and conscious, with left hemiplegia. [jamanetwork.com]

  She was then taken to a hospital where she achieved suboptimal seizure control, with daily tonic-clonic seizures and left hemiplegia during the following week. [ncbi.nlm.nih.gov]

  On the 5 th day, generalized seizures started again, as well as vomiting of gastric contents, cyanosis, and bradycardia. [scielo.br]

• Agitation

  Almost 84% of patients having a respiratory rate of > or = 30 breaths/minute associated with agitation and sweating were classified in the pulmonary edema group. [ncbi.nlm.nih.gov]

  Treatment of venomous Centruroides stings consists of bed rest, benzodiazepines for muscle spasms, and IV drugs as needed to control hypertension, agitation, and pain. Patients should take nothing by mouth for 8 to 12 hours after the bite. [merckmanuals.com]

  In children, severe involuntary motor activity, agitation, and respiratory difficulties can occur. No deaths have been reported for this species in the United States since 1968 (excluding deaths due to anaphylaxis). [visualdx.com]

• Slurred Speech

  Venomous scorpion stings occur most frequently in infants and children, and may cause shortness of breath, fluid buildup in the lungs, excess saliva, slurred speech, trouble swallowing, abnormal eye movements, muscle twitching, trouble walking, other [medpagetoday.com]

  You may have experienced a scorpion sting if you notice: • Sensitive Skin • Local Burning Pain • Slurred Speech • Breathing Problems • Body-Wide Numbness [scorpionspecialists.com]

  Serious symptoms start within minutes of the sting and may include: Increased salivation (foaming at the mouth or drooling) Blurred vision Trouble focusing Slurred speech Muscle twitches Abdominal cramps Seizures Trouble breathing If you see any of these [thesurvivaldoctor.com]

  speech Drooling Muscle twitches Abdominal pain and cramps Respiratory depression These symptoms usually subside within 48 hours, although stings from a bark scorpion can be life-threatening. [cdc.gov]

  Severe symptoms include shortness of breath, fluid in the lungs, breathing problems, excess saliva, blurred vision, slurred speech, trouble swallowing, abnormal eye movements, muscle twitching, thrashing of the arms and legs, trouble walking, and other [fda.gov]

• Paresthesia

  Edema Nausea and vomiting Hyperthermia Respiratory failure Erythema Urticaria Sweating Dysgeusia Grades of Scorpion Envenomation Grade I: Local pain and/or paresthesias Grade II: Local and remote pain and/or paresthesias Grade III: Local pain with paresthesias [lasvegasemr.com]

  The patient soon developed local pain and paresthesias followed by diaphoresis and somnolence. Approximately 24 hours after the sting, she began to convulse. [jamanetwork.com]

  The neurotoxins block ion channels, particularly sodium and potassium, causing pain and paresthesias. Secondary systemic effects are caused by massive release of acetylcholine and catecholamines. [visualdx.com]

  Table adapted from 3 Grade Signs and Symptoms Treatment I At the site of envenomation: Pain +/- paresthesias Positive tap test (severe pain increased with touch or percussion) 1. Support the airway 2. Provide pain control 3. [aliem.com]

• Hyperactivity

  For children, hyperactivity and erratic eye movement can manifest. Treatment Most species of scorpions living in the U.S. are not highly venomous, with the exception of Centruroides sculpteratus, the Arizona bark scorpion. [orkin.com]

  Neuromuscular overstimulation: There can be cranial as well as somatic nerve hyperactivity by the scorpion venom. Among the different types of scorpion venom, the neurotoxin is the most potent. [symptoma.com]

  Other types of drug overdose to be considered in children with restlessness, hyperactivity and abnormal behaviour are the anticholinergics and tricyclic antidepressants. [cmej.org.za]

Scorpion venom may or may not require extensive laboratory work, depending on the species of scorpion. Here, the laboratory studies that can be done are mentioned below:

• CBC: Complete blood count or CBC helps to ascertain leukocytosis and hemolysis in patient with scorpion sting. 
• Coagulation parameters: At higher concentration, the venom acts as an anticoagulant.  
• Measurement of glucose levels can help to evaluate hyperglycemia, which is often induced by the scorpion sting. 
• Urinalysis: Measuring the levels of creatine kinase and performing urinalysis can help assess motor rhabdomyolysis in patient with scorpion sting. In some cases, renal failure occur secondary to hemolysis.
• Pancreatitis is common from the venom of Tityus trinitatis stings.
• Liver parameters: Patient with the scorpion stings may have elevated levels of aspartate aminotransferase and alanine aminotransferase. 
• There is an increase in the levels of Interleukin (IL)–1 level in all the scorpion stings. In severe envenominations, there is an elevated levels of interferon-gamma, IL-6 and granulocyte-macrophage colony-stimulating factor.
• Arterial Blood Gas (ABG) indicates any respiratory distress caused due to the scorpion venom [8] [9].

• Abnormal Renal Function

  Numerous factors can trigger this syndrome, most commonly: acute elevation of blood pressure, abnormal renal function, and immunosuppressive therapy. [ncbi.nlm.nih.gov]

• Staphylococcus Aureus

  This was followed by a persistent high-grade fever which lasted for more than 2 weeks and was complicated by fatal Staphylococcus aureus infective endocarditis and septic pulmonary embolism. [ncbi.nlm.nih.gov]

In most cases, the treatment is supportive. It is advised to wash the region with soap and water. Patient may be advised to remove the jewelry as the body can swell in response to the sting. Applying cool compress has proved beneficial in most cases. Analgesics can help relieve pain that ensues after the sting. Choice of analgesic is acetaminophen as aspirin and ibuprofen can aggravate complications. Antibiotics are beneficial only in case of secondary infection [10].

In patients who are older than 6 years, death occurs rarely. A poor outcome is likely if the symptoms worsen 2-4 hours after the scorpion sting.

Complications

Severe complications of the scorpion sting are the allergic reactions which may be life-threatening. Signs and symptoms resemble the bee sting such as hives, difficulty in breathing, nausea and vomiting [5] [6].

Scorpion sting appears as a barb that contains the protein toxin. This toxin is not pure, but is a mixture of several proteins such as neurotoxin and protein inhibitors along with other similar substances.

The type of toxin depends on the species. This difference is believed to evolve to target a specific prey and vary from species to species. Only around 2% of the scorpions are dangerous to humans. In fact, maurotoxin and chlorotoxin are the two toxins used for the research of the diseases including cancer [2] [3].

Scorpion bites are common in the tropical and temperate regions of the globe. Most of the sting occurs during evenings of summer, outside the home. Though accurate data is not available, it is estimated that around 1.2 million people are stung by scorpion per year.

Deaths due to scorpion sting generally occurs secondary to the cardiovascular and respiratory failure within 24 hours of the sting. Children and elderly are more like to be killed by the scorpion sting. Though there is no racial predilection, according to the data, females are more susceptible to the scorpion venom because of lower body weight [4].

After the sting of the scorpion, the venom enters the human body through the blood (intravenous route). Generally, the peak concentration of the venom is reached after 30 minutes of the sting. It is believed that the more rapidly the venom reaches the bloodstream, the higher is its concentration in the blood with rapid onset of symptoms. The scorpion-venom is a water-soluble and heterogeneous mixture (the scorpion venom is composed of different concentrations of neurotoxin, cardiotoxin, hemolytic toxin, hyaluronidases, histamine, serotonin, etc.). The clinical effects of the venom are neuroanatomic, local tissue effect and neuromuscular with the primary targets being voltage-dependent ion channels. Some of the effects are as follows:

• Neuronal activity: The toxins cause the alteration of the ion channels. 
• Cardiopulmonary effects: The autonomic excitation caused by the scorpion venom can cause cardiovascular effects. 
• Neuromuscular overstimulation: There can be cranial as well as somatic nerve hyperactivity by the scorpion venom. 
• Among the different types of scorpion venom, the neurotoxin is the most potent. They are responsible for the impairment of the cell in the nerves, and muscles (including the cardiac muscle) as they alter the ion-channel permeability [3].

Scorpion sting can be prevented by taking some precaution such as wearing clothes after shaking them, or dislodging the shoes with scorpions. While going to the park, it is often advised to cover the entire body to avoid contact with this Arachnida. Use of pesticides in the regions with significant populations of scorpion can also work. It is also required to brush off the scorpion from the skin instead of slapping it as it is more likely to sting. People who are working in scorpion prone areas must use Scorpion glow or UV light to locate this organism.

Scorpions belong to the kingdom Animalia and class Arachnida. Belonging to the same class as spiders, mites and ticks, scorpions have a stinger at the last tail segment. The scorpion transmits the toxin through this stinger.

Though most of them are harmless, around 40 scorpions can deliver venom that can cause lethal damage to the humans, sometimes even causing death. Contact with scorpions is generally accidental. Scorpions are found in arid regions, temperate regions and deserts. Since the scorpions hunt at night, the chances of interaction with it, increases at night [1].

Definition

Scorpion sting is the transfer of the venom or toxin (neurotoxin and protein inhibitors) from the scorpion to the host. 

Cause

When one is exposed to the environment with scorpion, there is an increased chance of interaction between this Arachnida and humans. The complications that arise due to this interaction can be moderate (nausea, inflammation and vomiting) to life-threatening conditions. These arthropods are nocturnal that often resists stinging, unless threatened.

Symptoms

Most of the sting of the scorpions brings about only minor signs such as intense pain, numbness, slight swelling, and warmth in the region. Muscle twitching, sweating, vomiting, drooling and high blood pressure, restlessness and irregular heart rate are some of the severe symptoms of the condition.

Diagnosis

The doctor can ask about the personal history of the patient. This assists in making accurate diagnosis of the condition. If there are severe symptoms, blood and imaging tests may be performed to assess the impact of the venom.

Treatment

Once bitten by the scorpion, applying ice-pack to the region is considered as the first step. Removing jewelry from the body can prevent complications arising from swelling. Pain-killers can help alleviate pain. Anti-venom for some of the species of deadly scorpion is available.

1. Steen CJ, Schwartz RA. Arthropod bites and stings. In: Wolff K, Goldsmith LA, Katz SI, et al., eds. Fitzpatrick's Dermatology in General Medicine. 7th ed. New York, NY: McGraw-Hill; 2008:chap 210.
2. Bawaskar HS, Bawaskar PH. Scorpion sting: update. J Assoc Physicians India. Jan 2012;60:46-55.
3. Suchard J. Scorpion Envenomation. In: Auerbach PS, ed. Wilderness Medicine. 6th ed. Philadelphia, Pa: Mosby Elsevier; 2011:chap 53.
4. Chippaux JP, Goyffon M. Epidemiology of scorpionism: a global apprasial. Acta Trop. 2010/08;107:71-9.
5. Freire-Maia L, Pinto GI, Franco I. Mechanism of the cardiovascular effects produced by purified scorpion toxin in the rat. J Pharmacol Exp Ther. Jan 1974;188(1):207-13
6. Bahloul M, Chaari A, Dammak H, Samet M, Chtara K, Chelly H, et al. Pulmonary edema following scorpion envenomation: mechanisms, clinical manifestations, diagnosis and treatment. Int J Cardiol. Jan 10 2013;162(2):86-91
7. Bawaskar HS. Diagnostic cardiac premonitory signs and symptoms of red scorpion sting. Lancet. Mar 6 1982;1(8271):552-4
8. Guerra CM, Carvalho LF, Colosimo EA, Freire HB. Analysis of variables related to fatal outcomes of scorpion envenomation in children and adolescents in the state of Minas Gerais, Brazil, from 2001 to 2005. J Pediatr (Rio J). Nov-Dec 2008;84(6):509-15.
9. Amaral CF, Lopes JA, Magalhaes RA, de Rezende NA. Electrocardiographic, enzymatic and echocardiographic evidence of myocardial damage after Tityus serrulatus scorpion poisoning. Am J Cardiol. Mar 15 1991;67(7):655-7
10. Chippaux JP. Emerging options for the management of scorpion stings. Drug Des Devel Ther. 2012;6:165-73