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Antivenom for Scorpion Stings

Children with severe reactions to stings recovered quickly after receiving antivenom.

Stings from scorpions in the U.S. Southwest and Mexico can produce a neuromotor syndrome that, in its severe form, is characterized by uncoordinated hyperactivity with thrashing limbs, oculomotor and visual abnormalities, and respiratory compromise. Severe reactions are more common in children. An antivenom produced from various Mexican scorpion species (including some also found in the U.S.) was evaluated at two Arizona intensive care units, where 15 children (age range, 6 months to 18 years) were admitted within 5 hours of a scorpion sting with severe neuromotor syndrome; they were randomized to scorpion-specific antivenom or placebo.

Within 4 hours after treatment, the syndrome had resolved in all eight children who received antivenom and in only one who received placebo (P<0.001). Antivenom recipients also received substantially less midazolam during the first 4 hours. One hour after treatment, no antivenom recipients and six of seven placebo recipients had detectable plasma venom concentrations levels.

Comment: The antivenom used in this study is commercially available in Mexico but is available only on an investigational basis in the U.S. Few physicians will encounter children with serious reactions to scorpion stings, but this antivenom adds to our expanding storehouse of specific remedies for uncommon diseases. For example, a specific treatment for infant botulism is now available (JW Pediatr Adolesc Med Feb 24 2006). Physicians need to know where to call in case they encounter children with a specific disease that might have an antidote. I would start with a local poison control resource.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine May 13, 2009

Citation(s):

Boyer LV et al. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med 2009 May 14; 360:2090.

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