A study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation

M. J. Senthilkumar, P. Suresh Kumar, Saranya Nagalingam


Background: Scorpion stings, though not a big problem in many developed countries, it is a major public health problem in underdeveloped and in some developing countries all over the world. Objectives was to study on the clinical spectrum and electrocardiographic changes in scorpion sting envenomation.

Methods: This study was conducted in a tertiary care institute after obtaining the IEC clearance and informed consent from the patients for a period of 6 months from January 2018 to June 2018. All the patients admitted to the toxicology ward and general ward with scorpion envenomation during the study period were included in the study. A total number of 53 cases of scorpion envenomation and 20 healthy patients from the outpatient department of General medicine, were taken as controls.

Results: Fifty-nine percent of the patients presented with Grade 1 envenomation, seven percent with Grade 2 and thirty four percent with Grade 3 envenomation. Local pain (83%) and tachycardia (19%) were the commonest presenting symptom and sign respectively. Sinus tachycardia (6%) was the commonest ECG abnormality seen in the study. There was statistical significance in the relationship between ECG change and biochemical marker CK-MB.

Conclusions: Scorpion envenomation in adults needs to be studied to identify the high-risk groups and to assess the morbidity caused it. There was no mortality due to scorpion sting in the study period and significant correlation between the time delay and severity of envenomation was found which indicates a need for immediate medical care following scorpion sting.


ECG changes, Scorpion envenomation, Scorpion sting, Scorpion venom

Full Text:



Bawaskar HS, Bawaskar PH. Sting by red scorpion (Buthus tamulus) in Maharashtra state, India: A clinical study. Trans Roy Soc Med Hyg. 1989;83:858-60.

Erfati P. Epidemiology, symptomatology and treatment of Buthinae stings in: Arthopod venoms. Handbook of experimental pharmacology. Ed. Bettini S. New York, Springer-Verlog; 1978:312-315.

Mahadevan S: Scorpion sting. Indian J Pediatr. 2000;37:504-14.

Santhanakrishnan BR, Ranganathan G, Ananthasubramanian P, Raju VB. Cardiovascular manifestations of scorpion sting in children. Indian pediatrics. 1977 May;14(5):353-6.

Handergal NH, Malleraja Gowda K, Ramnath TE, Ramesh Babu KA. A clinical study of one hundred cases of scorpion sting. J Assoc Phys India. 1986;34:27-40.

Zlorkint, Miranda F: Proteins in scorpion venom toxic to mammals and insects. Toxicon. 1972;10:207-9.

Bawaskar HS, Bawaskar PH. Indian red scorpion envenoming. Indian J 75 Pediatr. 1998;65:383-91.

Bawaskar HS, Bawaskar PH. Management of cardiovascular manifestations of poisoning by the Indian red scorpion. Brit Heart J. 1992;68:478-80.

Amitai Y, Mines Y, Aker M, Goitein K. Scorpion sting in children. Clin Pediatr. 1985;24:136-40.

Mahaba HMA. Scorpion sting syndrome: Epidemiology, clinical presentation and management of 2240 cases. 1997;3:82-9.

Krifi MN, Kharrat H, Zghal K, Abdouli M, Abroug F, Bouchoucha S, et al. Development of an ELISA for the detection of scorpion venoms in sera of humans envenomed by Androctonus australis garzonii (Aag) and Buthus occitanus tunetanus (Bot): correlation with clinical severity of envenoming in Tunisia. Toxicon. 1998 Jun 1;36(6):887-900.

Gueron M, Reuben I, Sofer S: The cardiovascular system after scorpion envenomation. J Toxicol. 1992;30:215-58.

Touloun O, Silmani T. Boumzzough: A epidemiological survery of scorpion envenomation in South Western Morocco. J Venom Ani Toxins. 2001;7:199-218.

Ghalim N, El-Hafny B, Sebti F, Heikel J, Lazar N, Moustanir R, Benslimane A. Scorpion envenomation and serotherapy in Morocco. Am J Trop Med Hyg. 2000 Feb 1;62(2):277-83.

Dittrich K, Poer P, Smith NA. Scorpion sting syndrome-a ten year experience. Ann Saudi Med. 1995;15:148-55.

Yugandhar B, Radhakrishna Murthy K, Sattar SA. Insulin administration in severe scorpion envenoming. J Venom Anim Toxins. 1999;5:200-19.

Valdivia HH, Kirby MS, Lederer WJ, Coronado R. Scorpion toxins targeted against the sarcoplasmic reticulum Ca (2+)-release channel of skeletal and cardiac muscle. Proc Natl Acad Sci USA. 1992 Dec 15;89(24):12185-9.

Karnad DR. Hemodynamic patterns in patients with scorpion envenomation. Heart. 1998;79:485-99.

Neale JR. Scorpion sting syndrome in eastern Riyadh. Ann Saudi Med. 1990;10:383-3.