Episode 79- An Expert Talks: Scorpion sting vs. stimulant exposure in pediatric patients
Episode Summary:
What do scorpions and meth have in common? Tune in as Drs. Rebecca Gragg and Daniel Brooks share their insights in this tox episode
Show Notes:
Key Points:
“An Expert Talks: Scorpions sting vs. stimulant exposure in pediatric patients”:
– The bark scorpion is responsible for thousands of envenomations in adults and children in the Southwestern U.S.
– Bark scorpion stings can range from Grade I (localized pain/ paresthesia) to Grade IV (cranial nerve and skeletal muscle dysfunction) in severity
– In more severe cases, pediatric patients can present with drooling/excessive secretions, abnormal eye movements, tongue fasciculations, restlessness/ agitation, shaking of extremities, autonomic instability, hyperthermia, and hypertension/ tachycardia. Without a clear history, these symptoms can lead to broad differential diagnoses including stimulant (methamphetamine) exposure
– Stimulant exposures can present similarly with crying, agitation, tachycardia/ hypertension, hyperthermia, excessive muscle movements, and abnormal eye movements- making it difficult to differentiate between a bark scorpion sting and a stimulant exposure
– However, with a thorough exam, providers can distinguish between the two. Children exposed to stimulants can be distractible and have purposeful eye/ motor movements, which is not the case in scorpion envenomations. Scorpion stings also lead to rotatory nystagmus and opsoclonus, tongue fasciculations, and back arching forward/backward which is not found in stimulant exposures
– Treatment of scorpion stings is supportive and focuses mainly on airway control. For Grade III/IV stings, especially those causing excess secretions or threatening the airway, contact your poison control center or tox service to discuss use of the antivenom “Anascorp”
– Anascorp is an antibody that rapidly binds to and inhibits scorpion venom. It is given as 3 vials in 50 mLs of fluid over 10 minutes, but you can consider giving one vial at a time and re-dosing as needed up to a total of 5 vials. It takes 1-2 hours for full resolution of symptoms, but once the patient improves, they can safely discharge
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