Acute respiratory failure following scorpion stings: Anaphylaxis or severe systemic envenomation?

  • Austin Castillo
  • Pradeep Attaluri

Abstract

Scorpion stings can cause a range of reactions which includes severe systemic envenomation resulting in respiratory failure, cardiovascular collapse, and severe neurologic complications. Patients with allergies to scorpion venom or allergies to bee and ant venom can have anaphylactic reactions following scorpion stings. We report a patient who developed severe respiratory distress following 2-3 scorpion stings on her face. She required an emergency cricothyroidotomy and prolonged hospitalization, related in part to underlying comorbidity. Physicians caring for patients following scorpion stings need to remember that these patients can have severe reactions to the venom, including anaphylactic reactions. The initial management likely involves respiratory and cardiac resuscitation. These patients may have a very difficult intubation and require an emergency surgical airway.

Keywords: scorpion, envenomation, acute respiratory failure, anaphylaxis

Downloads

Download data is not yet available.

References

Mowry JB, Spyker DA, Brooks DE, et al. 2015 Annual

Report of the American Association of Poison Control

Centers’ National Poison Data System (NPDS): 33rd Annual

Report, Clinical Toxicology 2016; 54:924–1109.

Santos MSV, Silva CGL, Neto BS. Clinical and epidemiological

aspects of scorpionism in the world: a systematic

review. Wilderness and Environmental Medicine 2016; 27

(4):504–518.

Ortiz E, Gurrola GB, Schwartz E, et al. Scorpion venom

components as potential candidates for drug development.

Toxicon 2015;93:125–135.

Isbister GK, Bawaskar HS. Scorpion envenomation. New

Engl J Med 2014; 371(5):457–63.

Pandi K, Krishnamurthy S, Srinivasaraghavan R, et al. Efficacy

of scorpion antivenom plus prazosin versus prazosin

alone for Mesobuthus tamulus scorpion sting envenomation

in children: a randomized controlled trial. Arch Dis Child

;99:575–80.

Boyer LV, Theodorou AA, Berg RA, et al. Antivenom for critically

ill children with neurotoxicity from scorpion stings.

N Engl J Med 2009; 360(20):2090–8.

Nugent JS, More DR, Hagan LL, et al. Cross-reactivity

between allergens in the venom of the common striped scorpion

and the imported fire ant. J Allergy Clin Immunol 2004;

:383–386.

Lipps, BV, Khan, AA. Antigenic cross reactivity among the

venoms and toxins from unrelated diverse sources. Toxicon

; 38(7):973–80.

Insects and scorpions. Centers for Disease Control and

Prevention, Centers for Disease Control and Prevention,

https://www.cdc.gov/niosh/topics/insects/default.html, 1 July

Accessed 11-10-2017.

Heddle R, Golden D. Allergy to insect stings and bites. WAO,

August 2015, www.worldallergy.org/professional/allergic_

diseases_center/insect_allergy/. Accessed 24 Sept. 2017.

Armstrong EP, Bakall M, Skrepnek GH, et al. LV. Is scorpion

antivenom cost effective as marketed in the United States?

Toxicon 2013; 76:394–8.

Bawaskar HS, Bawaskar PH. Efficacy and safety of scorpion

antivenom plus prazosin compared with prazosin alone

for venomous scorpion (Mesobuthus tamulus) sting: randomized

open label clinical trial. BMJ 2011; 342:c7136.

Warrell DA. Guidelines for the management of snakebites.

Antivenom reactions. apps.searo.who.int/PDS_DOCS/

B4508.pdf.

LoVecchio F, Welch S, Klemens J, et al. Incidence of immediate

and delayed hypersensitivity to Centruroides antivenom.

Ann Emerg Med 1999; 34:615–619.

Sanaei-Zadeh H. Hypersensitivity reaction to scorpion

antivenom. Indian Dermatol Online J 2014; Suppl S1:51–2.

Published
2018-01-19
How to Cite
Castillo, A., & Attaluri, P. (2018). Acute respiratory failure following scorpion stings: Anaphylaxis or severe systemic envenomation?. The Southwest Respiratory and Critical Care Chronicles, 6(22), 47-50. https://doi.org/10.12746/swrccc.v6i22.435