# Scorpion Sting (Envenomation) - Category: acute - Review status: reviewed (every claim checked against a document named on this page) - Sources: Scorpion Toxicity - StatPearls, NCBI Bookshelf NBK430928 · Scorpion antivenom versus antivenom plus prazosin, Sohag University Hospitals (PMC11827372) · Egyptian National Drug Formulary - Antimicrobial 2023 · MSF Essential Drugs 2024 - paracetamol (oral) - Verified date: 2026-08 ## Verified against - Scorpion Toxicity - StatPearls, NCBI Bookshelf NBK430928 - MSF Essential Drugs 2024 - paracetamol (oral) - Egyptian National Drug Formulary - Antimicrobial 2023 ## Treatment metadata - No drug therapy in primary care (Emergency Referral) - Paracetamol — 500 mg — oral.solid - Tetanus toxoid — injection ## Complete treatment card ```text SCORPION STING (ENVENOMATION) Sources: Scorpion Toxicity - StatPearls, NCBI Bookshelf NBK430928 · Scorpion antivenom versus antivenom plus prazosin, Sohag University Hospitals (PMC11827372) · Egyptian National Drug Formulary - Antimicrobial 2023 · MSF Essential Drugs 2024 - paracetamol (oral) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (5) - Most stings cause local swelling, redness, and pain at the site [redness] - Sodium-channel toxin effects can cause seizure-like activity, clouding the picture especially when a child cannot give a history [seizures] - Overactive throat, diaphragm, and chest-wall muscles can progress quickly to airway collapse, sometimes needing intubation [collapse] - Some species cause cardiopulmonary effects: a fast heart rate, pulmonary oedema, and even cardiogenic shock [oedema · shock · tachycardia] - Local tissue death can turn up days to weeks after the sting, though this is uncommon [necrosis] SIGNS - what you find (2) - The sting site typically shows redness with local inflammation, and the patient can often point out the scorpion itself [redness] - Numbness and weakness at the site can also be found [numbness] TESTS (2) - Basic labs (CBC, metabolic panel, PT/INR, PTT, lipase) are reserved for suspected systemic involvement, mainly severe grade 3 to 4 envenomation - Scorpion stings are an uncommon but genuine cause of pancreatitis IF NOT THIS - what else fits (3) - Botulism, and caterpillar, centipede, or coral snake envenomation can look similar - Diphtheria, myasthenia gravis, and pancreatitis are also on the list - Ordinary insect bites, organophosphate poisoning, and rattlesnake or redback spider envenomation round out the differential Source StatPearls "Scorpion Toxicity" - disease-level clinical article Status traced to the source above Rx: Main treatment | Pain | Tetanus prophylaxis MAIN TREATMENT 1. NO DRUG THERAPY IN PRIMARY CARE (EMERGENCY REFERRAL) [1st line] Adult Any systemic sign - drooling, blurred vision, darting tongue movements, nystagmus, thrashing limbs, an arched back, sweating, vomiting or a fast pulse - is grade 3 or worse. Transfer immediately to a hospital holding VACSERA polyvalent antiscorpion antivenom. Telephone ahead. - Immediate emergency transfer Peds Send every stung child, whatever the grade looks like in the first hour. The same dose of venom into a small body is a higher dose, and the grade can climb while you are watching. Source Scorpion Toxicity - StatPearls, NCBI Bookshelf NBK430928 Why The two dangerous species in Egypt are Leiurus quinquestriatus and Androctonus crassicauda. Grade 1 is pain and pins-and-needles at the site; grade 2 is that pain spreading up the limb; grade 3 adds cranial nerve or neuromuscular signs; grade 4 has both and brings hyperthermia, rhabdomyolysis, pulmonary oedema and multi-organ failure. The hospital treatment is VACSERA polyvalent antiscorpion antivenom - 1 mL intramuscularly, or 1 to 5 vials in 5% glucose by infusion depending on severity, reassessed every 4 to 6 hours - and Sohag adds oral prazosin 30 micrograms/kg per dose, maximum 1 mg, four doses six hours apart, patient supine for three hours after the first. Caution Grade 1 is pain and pins-and-needles at the sting site and nothing else. Once the tingling has spread up the limb it is grade 2 - keep the patient under observation, do not send them home. Antivenom is not a primary-care drug. Do not spend time trying to find it locally; the transfer is the treatment. Prazosin is a hospital drug here for one reason - the first dose drops the blood pressure, which is why the patient stays supine for three hours after it. Clean the sting site and check tetanus cover on every sting that broke the skin. PAIN - give alongside 2. PARACETAMOL [add-on - not a substitute] Adult 1000 mg every 6 hours as needed, maximum 4000 mg in 24 hours x 1-2 days Peds 15 mg/kg/dose [child max 500 mg] (15 mg/kg per dose every 4-6 hours, maximum 60 mg/kg/day. Pain relief on the way to hospital, not a reason to keep the child in the clinic. Under 1 month: 10 mg/kg 3 or 4 times daily, maximum 40 mg/kg/day (MSF Essential Drugs 2024).) 3kg -> 45 mg/dose 4kg -> 60 mg/dose 5kg -> 75 mg/dose 6kg -> 90 mg/dose 7kg -> 105 mg/dose 8kg -> 120 mg/dose 9kg -> 135 mg/dose 10kg -> 150 mg/dose 11kg -> 165 mg/dose 12kg -> 180 mg/dose 13kg -> 195 mg/dose 14kg -> 210 mg/dose 15kg -> 225 mg/dose 16kg -> 240 mg/dose 17kg -> 255 mg/dose 18kg -> 270 mg/dose 19kg -> 285 mg/dose 20kg -> 300 mg/dose 21kg -> 315 mg/dose 22kg -> 330 mg/dose 23kg -> 345 mg/dose 24kg -> 360 mg/dose 25kg -> 375 mg/dose 26kg -> 390 mg/dose 27kg -> 405 mg/dose 28kg -> 420 mg/dose 29kg -> 435 mg/dose 30kg -> 450 mg/dose 31kg -> 465 mg/dose 32kg -> 480 mg/dose 33kg -> 495 mg/dose 34kg -> 500 mg/dose (capped) 35kg -> 500 mg/dose (capped) 36kg -> 500 mg/dose (capped) 37kg -> 500 mg/dose (capped) 38kg -> 500 mg/dose (capped) 39kg -> 500 mg/dose (capped) 40kg -> 500 mg/dose (capped) 41kg -> 500 mg/dose (capped) 42kg -> 500 mg/dose (capped) 43kg -> 500 mg/dose (capped) 44kg -> 500 mg/dose (capped) 45kg -> 500 mg/dose (capped) 46kg -> 500 mg/dose (capped) 47kg -> 500 mg/dose (capped) 48kg -> 500 mg/dose (capped) 49kg -> 500 mg/dose (capped) 50kg -> 500 mg/dose (capped) Source MSF Essential Drugs 2024 - paracetamol (oral) Why A grade 1 sting in an adult - pain at the site, nothing systemic - is treated with analgesia and observation, and nothing else. Analgesia does not change the grade, so it never replaces the decision to transfer. Caution Do not exceed maximum daily dose (risk of severe hepatotoxicity). Check total daily dose from all paracetamol-containing combination products. Reduce the maximum to 3000 mg/day in an adult under 50 kg, malnourished, or with liver disease. 500 mg is the per-dose ceiling used here for a child. 1000 mg is the adult dose and does not belong in a weight calculation - the daily 60 mg/kg limit is the one that binds first in any case. Egypt FEBRIMOL 500 MG 20 TAB. PHARCO 3.50 EGP (0.17/unit) CETAMOL 500 MG 20 TABS. MEMPHIS 8.00 EGP (0.40/unit) PARACETAMOL-MUP 500MG B.P. 20 TABS. MUP 13.00 EGP (0.65/unit) CETAL 500 MG 20 TABS. EIPICO 24.00 EGP (1.20/unit) ARKADOLOW 500 MG 30 F.C. TABS. UTOPIA 42.00 EGP (1.40/unit) PARAMOL 500MG 20 TAB. MISR 38.00 EGP (1.90/unit) ADOL 500MG 24 CAPLETS JULPHAR 32.00 EGP AUGICETAMIDE 500 MG 20 SACHETS AUG PHARMA 50.00 EGP FEBRIMOL ORAL DROPS 20 ML PHARCO 4.00 EGP -> ? strength differs, ? different route - not oral solid THERA-LO 3.2G/100ML ORAL SUSP. 100 ML PHAROPHARMA 5.00 EGP -> ? strength differs, ? different route - not oral solid TETANUS PROPHYLAXIS - give alongside 3. TETANUS TOXOID [add-on - not a substitute] Adult 0.5 mL IM single dose into deltoid muscle - single dose Peds 2 months and over: 0.5 mL IM single dose (usually given as DTaP/Tdap) (Children >= 2 months: 0.5 mL IM single dose (usually given as DTaP/Tdap)) Source Egyptian National Drug Formulary - Antimicrobial 2023 Why Wound cleaning and tetanus prophylaxis are part of the supportive care of any sting that broke the skin. Caution A sting is a puncture wound - treat it as tetanus-prone and give a booster if the last dose was more than 5 years ago. Thorough wound cleaning is mandatory. Egypt no Egyptian brand matched - prescribe by generic name Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)