11 February, 2013

A updated review on the treatment of scorpion envenomations

Jean-Philippe Chippaux has recently published an updated review on the options for treating scorpion envenomations. On average 1.5 million envenomations happen worldwide every year, causing 2600 deaths. Updated information about the treatment of scorpin stings is therefore very important.

The objective of this review is to update knowledge on the management of scorpion stings and treatment of scorpion envenomings, to discuss the advantages and limitations of early immunotherapy versus medical resuscitation, and to offer a standardized management plan based on a combination of both strategies.

Scorpion stings are common in many tropical countries. Although most scorpion stings cause only localized pain without life-threatening envenoming, about one third of stings cause systemic envenoming which can result in death. Children are particularly sensitive to scorpion envenoming. The severity of scorpion stings is related to the presence of neurotoxins in the venom that cause a sudden release of neurotransmitters from the autonomic nervous system, predominantly sympathetic. There is also a strong inflammatory response that worsens symptoms, including those of a respiratory nature. Several vital functions may be directly affected, including the cardiovascular, respiratory, and neuromuscular systems. Hypertension is constant at the beginning of systemic envenoming and sometimes has a severe cardiac and respiratory impact. Although controversial, immunotherapy is the only etiological treatment. Administered early, it prevents many complications and improves the outcome. New antivenoms are highly purified immunoglobulin fragments, the efficacy and safety of which are excellent. As a consequence, adverse reactions to antivenoms are now very rare and usually mild, which should limit any reluctance regarding their routine use. Symptomatic treatment is still necessary to support immunotherapy, especially in cases of delayed arrival at hospital. A combination of both approaches should be considered, based on local resources and constraints.

Chippaux JP. Emerging options for the management of scorpion stings. Drug Des Devel Ther. 2012 03 Jul;6:165-73. [Free full text]

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