101  Scorpion bites

101.1 Introduction

Scorpion stings are an important but often under-recognised cause of acute paediatric morbidity in many parts of West Africa, including northern Ghana. While most scorpion stings cause only local pain and swelling, some species—particularly those belonging to the Buthidae family—can cause severe systemic envenomation. Children are disproportionately affected due to their smaller body mass and increased vulnerability to venom toxicity.

This chapter provides an evidence-based and contextually appropriate guide for medical students and paediatric residents on the clinical features, diagnosis, and management of scorpion stings, with emphasis on species found in Ghana and neighbouring West African countries.

101.2 Epidemiology

• Scorpions are common in Northern Ghana, arid areas of the Upper East and Upper West Regions, and throughout Sahelian West Africa.
• Stings occur mostly during the dry season when scorpions enter homes, firewood piles, shoes, and bedding.
• Children under 12 years have a higher risk of severe systemic effects.
• Mortality from severe stings across Africa is highest in infants and young children.

Common medically important scorpion families in West Africa:

• Buthidae (most dangerous)
• Scorpionidae (less toxic but painful)

101.3 Pathophysiology

Scorpion venom is a complex mixture of neurotoxins, cardiotoxins, and inflammatory mediators. The predominant mechanism is overstimulation of the autonomic nervous system.

101.3.1 Neurotoxic Effects

• Alpha- and beta-toxins affect sodium and potassium channels.
• Results in massive catecholamine release (epinephrine, norepinephrine).
• Leads to sympathetic overactivity.

101.3.2 Parasympathetic Effects

• Salivation, sweating, vomiting, bronchorrhoea.

101.3.3 Cardiovascular Effects

• Myocarditis, arrhythmias, and cardiogenic pulmonary oedema may occur.

101.3.4 Local Effects

• Intense pain
• Erythema and swelling
• Secondary infection is rare

101.4 Clinical Features

Severity varies from mild local reactions to life-threatening systemic involvement.

101.4.1 Local Features

• Immediate, intense pain
• Burning, tingling
• Minimal swelling or erythema
• Pain out of proportion to visible injury

101.4.2 Systemic Features

Systemic envenomation is more common in children.

101.4.2.1 Autonomic Storm

• Profuse sweating
• Salivation and lacrimation
• Vomiting
• Priapism in boys

101.4.2.2 Cardiovascular

• Tachycardia or bradycardia
• Hypertension (early)
• Hypotension (late/severe)
• Arrhythmias
• Shock

101.4.2.3 Respiratory

• Tachypnoea
• Wheezing
• Pulmonary oedema
• Respiratory failure

101.4.2.4 Neurological

• Agitation
• Muscle twitching
• Ataxia
• Seizures (rare)

101.4.3 Grading Severity

• Mild: Local symptoms only
• Moderate: Local + mild systemic features
• Severe: Autonomic storm, shock, respiratory distress

101.5 Investigations

Diagnosis is mainly clinical. Useful tests include:

• Regular monitoring of vitals
• Serum electrolytes and glucose
• ECG for arrhythmias
• Chest X-ray if pulmonary oedema suspected
• Echocardiography in severe cases

Do not delay treatment for investigations.

101.6 Management

101.6.1 First Aid at Community Level

Caregivers should: - Keep the child calm and still

• Wash the site with soap and water
• Avoid incisions, suction, herbs, or tight tourniquets
• Avoid direct ice application

101.6.2 Analgesia

• Paracetamol or ibuprofen for mild pain
• Morphine for severe pain (avoid pethidine)

101.6.3 Local Care

• Clean with antiseptic
• Cold compress (not direct ice)
• Tetanus prophylaxis

101.6.4 Management of Systemic Envenomation

101.6.4.1 Supportive Care (Mainstay in Ghana)

• Oxygen as needed
• Establish IV access
• Continuous monitoring
• Benzodiazepines for agitation

101.6.4.2 Cardiovascular Support

• Treat severe hypertension with hydralazine
• Use cautious IV fluids for hypotension
• Consider inotropes for persistent shock
• Use diuretics for pulmonary oedema

101.6.4.3 Neurological Care

• Benzodiazepines for seizures
• Correct hypoxia and metabolic abnormalities

101.6.5 Antivenom

• Highly effective but rarely available in Ghana
• Use in moderate to severe cases where available
• Monitor closely for anaphylaxis

101.6.6 Antibiotics

Not routinely required; consider only if:

• Cellulitis
• Immunosuppression
• Secondary bacterial infection suspected

101.7 Complications

• Cardiogenic pulmonary oedema
• Shock
• Arrhythmias
• Myocarditis
• Acidosis
• Multiorgan dysfunction (rare)
• Death

101.8 Prognosis

• Most children recover completely with timely supportive care.
• Severe stings can be fatal without quick intervention.
• Early recognition and good supportive care improve outcomes significantly.

101.9 Prevention

101.9.1 Community-Level

• Clear debris and firewood around homes
• Shake out clothing and shoes
• Use bed nets
• Improve household lighting
• Public education campaigns

101.9.2 Health System-Level

• Improve emergency care capacity
• Advocate for availability of antivenoms
• Strengthen referral systems

101.10 Key Points

• Scorpion stings are an important cause of paediatric emergencies in northern Ghana.
• Autonomic storm is characteristic of severe envenomation.
• Supportive care is the main treatment due to limited antivenom availability.
• Children can deteriorate quickly—continuous monitoring is critical.
• Prevention strategies reduce incidence substantially.

101.11 Further Reading

1. Chippaux JP. Emerging options for the treatment of scorpion stings. Toxicon.
2. Ministry of Health Ghana. Standard Treatment Guidelines.
3. WHO. Scorpion Sting: Treatment and Prevention Manual.
4. Ismail M. The scorpion envenoming syndrome. Toxicon.
5. Boyer LV. Management of scorpion stings in children. Pediatric Emergency Care.