Scorpion sting is common in rural areas or countryside. Clinical symptoms of scorpion sting can manifest over 12 to 24 hours and hence patient needs to be monitored appropriately. The grades of symptoms are:
- Grade 1 – severe pain radiating along the dermatome, local edema but no systemic involvement.
- Grade 2 – vomiting, profuse sweating, ice cold extremities, hypersalivation, thick mucus secretion, lacrimation, pin-point pupils, diarrhea, abdominal distension, priapism, bradycardia and/or hypotension.
- Grade 3 – (within one hour) – restlessness, marked tachycardia, dilated pupils, hyperglycemia, hypertension, toxic myocarditis, cardiac failure and/or pulmonary edema.
Medications:
- Apply ice pack to the affected area.
- Nummit spray (Lidocaine 15% w/w) – spray over bitten area for topical analgesia.
- Inj. Xylocaine (Lignocaine 2%) as ring block to reduce pain.
- Tab. Prazopress 1 (Prazosin 1 mg) – 1 tablet as quickly as possible. Keep the patient supine to avoid “first dose phenomenon” and hospitalise patient immediately. Repeat tab. Prazopress 1 after 3 hours and then every 6 hours till extremities are warm, dry and peripheral veins are visible (maximum dose – 5 mg in a day). In case of vomiting, administer via nasograstric tube. Tab. Prazopress 1 can be administered irrespective of blood pressure provided there is no hypovolemia.
- Tab. Combiflam (Ibuprofen 400 mg, Paracetamol 325 mg) 1 tablet thrice a day.
- Treat hypovolemia with adequate fluids via oral or nasogastric route. Prevent hypervolemia if intravenous fluids are used.
For pulmonary edema
- Propped up position and oxygen therapy
- Inj. Lasix (Furosemide 10 mg/ml) 4 mls i.v. over 2 minutes. Repeat the dose if there is no adequate response within one hour.
- If systolic blood pressure > 100 mmHg – start Glyceryl trinitrate infusion.
- If systolic blood pressure < 100 mmHg – start Dobutamine infusion.
- Consider intubation and mechanical ventilation if patient has cardiorespiratory deterioration.
- Anti- scorpion venom serum – reconstitute 1 vial in 10 ml sterile water. 3 ml of the anti-venom can be given every 15 minutes intramuscularly till symptoms improve. In case of pulmonary edema, give anti-venom intravenously.
Supportive treatment:
- Inj. Voveran (Diclofenac 75 mg/ml) i.m. if patient is unable to tolerate tablets.
Investigations:
- ECG – to identify evidence of cardiac involvement.
- Chest X ray – to rule out pulmonary oedema.
- Blood glucose level – to rule out hyper or hypoglycemia.
Referral:
In severe cases refer patient urgently to secondary or tertiary care where facilities for ICU and ventilation are available.