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
ER-Rx Episode 79

Please click HERE to leave a review of the podcast!


Leave a Reply

Your email address will not be published. Required fields are marked *

Recent Reviews/ Comments

“Love this podcast for anyone working in an ER or ICU. If you aren’t a pharmacist you will still get tons of useful information to improve your practice. Adis has a knack for finding a happy balance between explaining the pharmacokinetics and practical use for patients at the bedside. Highly recommend!”

–  NotAPharmacist, Apple Podcasts review 

“Perfect amount of knowledge in a great length to refresh ICU and ED topics. Explains concepts in an easy to understand fashion”

–  RxLaura, Apple Podcasts review

“I love listening to this podcast because I can listen to 1 or 2 on my way to work and it provides great info! As a paramedic, this podcast has really helped me understand the “why” we give certain meds.”

cresjr, Apple Podcasts review

“Ideal podcast to listen on the way to my shift. Learning points throughout!”

andmatjos, Apple Podcasts review

“I’m currently in my last year of pharmacy school […] I just happen to come across your podcast on YouTube as I was trying to find a good explanation regarding the misleading sulfa allergy in non-antibiotic sulfonamides. Your explanation was great. I can’t believe I’m only now finding out about your podcasts but please continue to make them for as long as you can. Prospective pharmacists, such as myself, really appreciate you taking the time to put such great educational content out there.”

– S.P., Pharmacy Student

“Adis does a wonderful job of gathering the evidence-based answers to the hard questions that we all get as pharmacists and putting them into a nice, neat package.”

– rebroush1, Apple Podcasts review

“This is a great podcast to listen to at work and is not too overwhelming and well put together. Highly recommended for anyone in healthcare, even outside of emergency medicine.”

Peelage, Apple Podcasts review

“Great reviews on drug-related topics with useful details on drug mechanisms, pharmacodynamics and administration considerations as well as data to support recommendations. Great for pharmacists, providers and learners!”

-JaayyZzee, Apple Podcasts review

“I found the topics very helpful. I have been recommending this show to pharmacy students and residents, who are also enjoying it.”

hvgjnfd, Apple Podcasts review

“As a PA, I found this very informative. I like that the episodes are short, making them easy to listen to on my way to and from work. Would love to hear more pediatric topics!”

-Pediatric PA, Apple Podcasts review

“Good podcast thats very informative for all healthcare providers. Very easy to listen to and enjoy.”

-Bradlley88, Apple Podcasts review