Autonomic dysfunctions in patients with scorpion sting: early predictors of severe disease


  • Kumaraswamy R. C. Gadari Department of Medicine, Basaveshwara Medical College and Research Centre, Chitradurga, Karnataka, India
  • Sudha Madhavi Kalli Mathada Department of Ophthalmology, Basaveshwara Medical College and Research Centre, Chitradurga, Karnataka, India


Scorpion sting, Autonomic storm, Autonomic dysfunction, Prognostic indicators


Background: Scorpion sting envenomation is a common medical emergency accounting for nearly 2.8% of annual intensive cardiac care unit admissions and much more outpatient visits. Symptomatology and severity of envenomation varies greatly. Autonomic storm may end up in loss of life.

Methods: This is a clinical study conducted between April 2011 and February 2013. Patients with moderate to severe envenomation were examined at frequent intervals for various autonomic manifestations. Various demographic, clinical and electrocardiogram (ECG) changes were studied for their association with severity of envenomation. Results were statistically evaluated for their significance.

Results: A total of 106 patients were studied with a mean age of 27.25 years and peak incidence between 11 and 30 year age groups. 91% reached the hospital within 12 h. 7.55% of the patients had Grade 2, 74.53% had Grade 3 and 17.92% had Grade 4 disease, all grades were common in 11-30 age group. Autonomic disturbances; profuse sweating seen in 72.6% of the patients that showed a strong correlation with pulmonary edema and ECG manifestations (p ≤ 0.0001). Pulmonary edema was present in 37.7% of the patients. Excessive salivation was seen in 28.3%, and persistent nausea and vomiting were seen in 24.5%, both were associated with severe cardio-pulmonary manifestations. Hypotension was present in 14.2% of patients that was associated with poor prognosis (p ≤ 0.0001).

Conclusions: Scorpion sting envenomation is a life-threatening problem requiring immediate attention. Presence of autonomic dysfunctions; profuse sweating, excessive salivation, persistent nausea and vomiting, hypotension at presentation are poor prognostic factors.


Das S, Nalini P, Ananthakrishnan S, Ananthanarayanan PH, Balachander J, Sethuraman KR, et al. Scorpion envenomation in children in southern India. J Trop Med Hyg. 1995;98(5):306-8.

Mahadevan S. Scorpion sting envenomation. Indian Pediatr. 2000;37:504-11.

Cheng D, Dattaro JA, Yakobi R. Scorpion Envenomation. E Med. 2002. Available at Accessed 9 April 2014.

Bawaskar HS, Bawaskar PH. Prazosin in management of cardiovascular manifestations of scorpion sting. Lancet. 1986;1(8479):510-1.

Bawaskar HS, Bawaskar PH. Symptoms, signs and management of Indian red scorpion envenomation, Medicine update. India: APICON, API; 1998: 475-6.

Gueron M, Yaron R. Cardiovascular manifestations of severe scorpion sting. Clinicopathologic correlations. Chest. 1970;57(2):156-62.

Poon-King T. Myocarditis from scorpion stings. Br Med J. 1963;1(5327):374-7.

Rajarajeswari G, Sivaprakasam S, Viswanathan J. Morbidity and mortality pattern in scorpion stings. (A review of 68 cases). J Indian Med Assoc. 1979;73(7-8):123-6.

Ditrich K, Power AP, Smith NA. Scorpion sting syndrome – A ten year experience. Ann Saudi Med. 1995;15(2):148-55.

Bahloul M, Chabchoub I, Chaari A, Chtara K, Kallel H, Dammak H, et al. Scorpion envenomation among children: clinical manifestations and outcome (analysis of 685 cases). Am J Trop Med Hyg. 2010;83(5):1084-92.

Bouaziz M, Bahloul M, Hergafi L, Kallel H, Chaari L, Hamida CB, et al. Factors associated with pulmonary edema in severe scorpion sting patients – A multivariate analysis of 428 cases. Clin Toxicol (Phila). 2006;44(3):293-300.

Bawasskar HS. Diagnostic cardiac premonitory signs and symptoms of red scorpion sting. Lancet. 1982;1(8271):552-54.

Sofer S, Gueron M. Vasodilator and hypertensive encephalopathy fallowing scorpion envenomation in children. Chest. 1990;97(1):118-20.

Biswal N, Mathai B, Bhatia BD. Scorpion sting envenomation: complication and management. Indian Pediatr. 1993;30(8):1055-9.






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