# Scorpion Sting in Children

> Scorpion sting in children for NEET-PG Paediatrics covering Indian red scorpion envenomation, autonomic storm, myocarditis, pulmonary oedema and prazosin use.

- Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/scorpion-sting-in-children
- Exam / course: NEET-PG · Subject: Paediatrics
- Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team
- First published: 2026-10-14
- Last updated: 2026-10-14
- Reference basis: Goldfrank's Toxicologic Emergencies; IAP Textbook of Pediatrics
- How to cite: "Scorpion Sting in Children", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/scorpion-sting-in-children

## Direct answer

Scorpion sting in children is envenomation that triggers a catecholamine-driven autonomic storm, most often from the Indian red scorpion, and the heart and lungs decide the outcome. Myocarditis and cardiogenic pulmonary oedema are the usual causes of death, not the local sting, so any child with systemic features needs continuous cardiac monitoring and treatment of the storm.

## What you must remember

- **Culprit:** the Indian red scorpion, Hottentotta tamulus, is the species most responsible for serious envenomation in India.
- **Mechanism:** venom neurotoxins delay sodium-channel inactivation and trigger massive catecholamine release, producing tachycardia, hypertension, sweating, restlessness and vomiting.
- **Cardiac injury:** myocarditis, arrhythmias and left ventricular dysfunction can lead to cardiogenic pulmonary oedema, the usual cause of death.
- **Work-up:** ECG, serial troponin, echocardiography and chest radiograph, with blood glucose checked because hyperglycaemia is common.
- **Preferred drug:** prazosin, an alpha-1 blocker, treats the hypertension and pulmonary oedema driven by the storm.
- **Antivenom:** indicated for systemic features such as pulmonary oedema or shock; local pain alone needs symptomatic care.
- **Observation:** children with systemic signs need monitoring for at least 24 hours, since pulmonary oedema can appear late.

## Managing the autonomic storm step by step

A six-year-old boy reaches the emergency department forty minutes after a sting on the hand. He is restless, drenched in sweat and has vomited twice.

1. **Classify the sting:** Local pain and paraesthesia need observation alone, while sweating, vomiting, restlessness or hypertension mark systemic envenomation.
2. **Monitor continuously:** Cardiac monitoring, pulse oximetry and frequent blood pressure checks, since the storm can evolve over hours.
3. **Investigate the heart:** ECG for ischaemic or arrhythmic change, with serum troponin and echocardiography to look for myocarditis and ventricular dysfunction.
4. **Control the storm:** Prazosin lowers catecholamine-driven hypertension and afterload; avoid beta-blockers, which leave alpha stimulation unopposed and can worsen pulmonary oedema.
5. **Give antivenom:** Specific scorpion antivenom is reserved for systemic envenomation, given according to local protocol.
6. **Support the lungs:** Oxygen, non-invasive ventilation or intubation for pulmonary oedema, with inotropes if shock develops.

Documenting the time of the sting, the number of stings and the first symptoms helps the team judge the trajectory.

## High-yield viva angles

Scorpion sting questions reward recognising the storm and avoiding the wrong drug.

- **Trap:** choosing a beta-blocker for the tachycardia and hypertension. — **Correct:** beta-blockade leaves alpha stimulation unopposed and can worsen pulmonary oedema; prazosin is the preferred agent.
- **Trap:** deciding the child is safe because the local sting looks minor. — **Correct:** systemic features, not local pain, define severity, and cardiac complications can appear late.
- **Trap:** treating the pulmonary oedema as simple fluid overload. — **Correct:** the oedema is driven by catecholamine-raised afterload, so reducing afterload with prazosin addresses the cause.

## Frequently asked questions

### Which scorpion causes most serious stings in India?

The Indian red scorpion, Hottentotta tamulus, is the species most responsible for serious scorpion envenomation in India. Its neurotoxic venom underlies the autonomic storm seen in affected children.

### Why are beta-blockers avoided in scorpion sting?

Scorpion sting produces a catecholamine surge, and beta-blockers leave the alpha-adrenergic vasoconstriction unopposed. This raises afterload and can worsen pulmonary oedema, so prazosin is preferred instead.

### Does every scorpion sting in a child need antivenom?

No, a local sting with pain and paraesthesia is managed symptomatically. Scorpion antivenom is reserved for systemic envenomation such as pulmonary oedema, shock or persistent autonomic instability.

### What is the usual cause of death after scorpion sting?

Cardiogenic pulmonary oedema, arising from myocarditis and catecholamine-driven hypertension, is the usual cause of death. Early cardiac monitoring and afterload reduction are the main protections against it.