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scorpion sting

Epidemiology: - 1 million cases worldwide annually [4] Clinical manifestations: 1) local itching 2) regional paresthesias 3) diaphoresis 4) dyspnea 5) sialorrhea 6) lacrimation 7) muscle pain 8) nausea/vomiting 9) tachycardia 10) hypotension - cardiogenic shock in severe cases [4] 11) involuntary motor activity, may progress to seizures 12) cranial nerve dysfunction Laboratory: 1) complete blood count (CBC) & chem7 - leukocytosis & hyperglycemia typical of stress reaction 2) generally laboratory tests not useful 3) severe reactions a) elevated serum creatine kinase b) abnormal renal function tests 1] serum urea nitrogen 2] serum creatinine c) abnormal coagulation studies 1] prothrombin time (PT) 2) activated partial thromboplastin time (aPTT) 3) increased D-dimer Complications: - mortality is lower than that from snake envenomation - among children, a risk of death [4] Differential diagnosis: - insecticide poisoning Management: 1) cool compresses 2) analgesics 3) Sawyer extractor (extracts venom with negative pressure) 4) tetanus prophylaxis 5) treat hypertension & tachycardia with beta blockers 6) ICU for acute pulmonary edema & cardiogenic shock [4] 7) scorpion antivenin (Anascorp) - evidence for effectiveness not uniformly strong [4]

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References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 1172-74
  2. Boyer LV et al Antivenom for critically ill children with neurotoxicity from a scorpion sting. N Engl J Med 2009 May 14; 360:2090. PMID: 19439743
  3. FDA NEWS RELEASE: August 3, 2011 FDA approves the first specific treatment for scorpion stings http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm266611.htm
  4. Isbister GK and Saluba Bawaskar H Scorpion Envenomation N Engl J Med 2014; 371:457-463 PMID: 25075837 http://www.nejm.org/doi/full/10.1056/NEJMra1401108