Episode 79- An Expert Talks: Scorpion sting vs. stimulant exposure in pediatric patients
What do scorpions and meth have in common? Tune in as Drs. Rebecca Gragg and Daniel Brooks share their insights in this tox episode
“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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