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Scorpion Sting: A Review of 121 Cases

Scorpions

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Scorpion sting is a hazardous and potentially lethal condition. One hundred twenty one scorpion sting patients were admitted to hospitals in Mahad Maharashtra state, India, during 1986–89. Sixty six (54.5%) victims had hypertension (mean blood pressure 96 to 160 [average 118.6] mm Hg). Twenty four (19.5%) victims demonstrated tachycardia, with heart rates ranging from 110 to 215 (average 156) beats per minute.

Twenty two (18.8%) had pulmonary edema, while nine (8.5%) died. Analysis of our data suggests that cardiovascular morbidity and mortality depends upon the time between the stings hospitalization or administration of vasodilators. Current management of scorpion envenomation consists of rapid reduction of hypertension with sublingual nifedipine, postsynaptic alpha adrenergic blockade with prazosin hydrochloride, and digoxin therapy for myocardial failure. Massive pulmonary edema can be treated with sodium nitroprusside. In our setting, mortality is reduced by early hospitalization, even though specific antivenin is not available in India.

Key words: Sting, envenomation, pulmonary edema, vasodilators
Introduction
Scorpion envenomations are common in tropical and subtropical regions. They are frequent occurrences in rural India. Buthotus tamulus stings are frequent in coastal areas of India. The venom of this species is a potent autonomic stimulator. Severity of symptoms depends upon the size of the victim, season, and time lapse between sting and hospitalization. Vomiting, profuse sweating, priapism, mild pain at the sting site, local urticaria and cool extremities are early signs of autonomic stimulation due to scorpion sting. Palamneus gravimanus is a larger species present in our region, but does not cause systemic manifestations with its painful sting. High mortality from scorpion stings has been reported from Israel and Brazil. P. M. Mundle from India reported 23 deaths out of 78 cases from our region. However, no deaths occurred in Israel during 1989, irrespective of whether or not antiserum was administered. Scorpion antivenin is not available in India.

It has been argued that its availability would not reduce morbidity and mortality, because scorpion venom is very rapidly distributed to the tissue, with an estimated half life of 5–6 min, peak tissue concentrations of venom are reached within 37 min.

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