Skip to main content

North American Scorpion Envenomations

  • Reference work entry
  • First Online:
Clinical Toxinology in Australia, Europe, and Americas

Part of the book series: Toxinology ((TOXI))

  • 886 Accesses


The Arizona bark scorpion, Centruroides sculpturatus, is the only scorpion endemic to the United States that produces a systemic envenomation in humans. Most stings do not result in serious symptoms however, and children are much more likely than adults to experience life-threatening effects. Serious envenomations are classified as Grade III and Grade IV. Findings include neuromuscular hyperactivity, with myoclonic muscle movements, fasciculations, thrashing and twisting of the torso, and restless agitation. Cranial nerve findings also occur and include opsoclonus, with dysconjugate and roving eye movements, as well as tongue fasciculations, hypersalivation, incoordination of pharyngeal muscles, and stridor. Local tissue findings at the sting site do not occur. Severe bark scorpion envenomation may be managed with supportive care and airway interventions as needed. Deaths occur from respiratory failure and hypoxia. An anti-Centruroides antivenom is available for treatment of serious bark scorpion stings. The antivenom reverses clinical toxicity within about an hour of administration. With or without antivenom treatment, most patients have full recovery from the envenomation in about 24 h.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 299.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 379.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others


  • Aksel G, Guler S, Dogan NO, Corbacioglu SK. A randomized trial comparing intravenous paracetamol, topical lidocaine, and ice application for treatment of pain associated with scorpion stings. Hum Exp Toxicol. 2015;34(6):662–7.

    Article  CAS  PubMed  Google Scholar 

  • Boyer LV, Theodorou AA, Berg RA, Mallie J, Chavez-Mendez A, Garcia-Ubbelohde W, et al. Antivenom for critically ill children with neurotoxicity from scorpion stings. N Engl J Med. 2009;360(20):2090–8.

    Article  CAS  PubMed  Google Scholar 

  • Boyer L, Degan J, Ruha AM, Mallie J, Mangin E, Alagon A. Safety of intravenous equine F(ab’)2: insights following clinical trials involving 1534 recipients of scorpion antivenom. Toxicon. 2013;76:386–93.

    Article  CAS  PubMed  Google Scholar 

  • Calderon-Aranda ES, Riviere G, Choumet V, Possani LD, Bon C. Pharmacokinetics of the toxic fraction of Centruroides limpidus limpidus venom in experimentally envenomed rabbits and effects of immunotherapy with specific F(ab’)2. Toxicon. 1999;37(5):771–82.

    Article  CAS  PubMed  Google Scholar 

  • Campos FV, Chanda B, Beirao PS, Bezanilla F. Beta-scorpion toxin modifies gating transitions in all four voltage sensors of the sodium channel. J Gen Physiol. 2007;130(3):257–68.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Campos FV, Chanda B, Beirao PS, Bezanilla F. Alpha-scorpion toxin impairs a conformational change that leads to fast inactivation of muscle sodium channels. J Gen Physiol. 2008;132(2):251–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Chase P, Boyer-Hassen L, McNally J, Vazquez HL, Theodorou AA, Walter FG, et al. Serum levels and urine detection of Centruroides sculpturatus venom in significantly envenomated patients. Clin Toxicol (Phila). 2009;47(1):24–8.

    Article  CAS  Google Scholar 

  • Coorg V, Levitan RD, Gerkin RD, Muenzer J, Ruha AM. Clinical presentation and outcomes associated with different treatment modalities for pediatric bark scorpion envenomation. J Med Toxicol. 2017;13(1):66–70.

    Article  CAS  PubMed  Google Scholar 

  • Corzo G, Espino-Solis GP. Selected scorpion toxin exposures induce cytokine release in human peripheral blood mononuclear cells. Toxicon. 2017;127:56–62.

    Article  CAS  PubMed  Google Scholar 

  • Curry SC, Vance MV, Ryan PJ, Kunkel DB, Northey WT. Envenomation by the scorpion Centruroides sculpturatus. J Toxicol Clin Toxicol. 1983;21(4–5):417–49.

    Article  PubMed  Google Scholar 

  • Devaux C, Jouirou B, Naceur Krifi M, Clot-Faybesse O, El Ayeb M, Rochat H. Quantitative variability in the biodistribution and in toxinokinetic studies of the three main alpha toxins from the Androctonus australis hector scorpion venom. Toxicon. 2004;43(6):661–9.

    Article  CAS  PubMed  Google Scholar 

  • Gibly R, Williams M, Walter FG, McNally J, Conroy C, Berg RA. Continuous intravenous midazolam infusion for Centruroides exilicauda scorpion envenomation. Ann Emerg Med. 1999;34(5):620–5.

    Article  CAS  PubMed  Google Scholar 

  • Hiller K, Jarrod MM, Franke HA, Degan J, Boyer LV, Fox FM. Scorpion antivenom administered by alternative infusions. Ann Emerg Med. 2010;56(3):309–10.

    Article  PubMed  Google Scholar 

  • Isbister GK, Bawaskar HS. Scorpion envenomation. N Engl J Med. 2014;371(5):457–63.

    Article  CAS  PubMed  Google Scholar 

  • Kang AM, Brooks DE. Nationwide scorpion exposures reported to US poison control centers from 2005 to 2015. J Med Toxicol. 2017;13(2):158–65.

    Article  CAS  PubMed  Google Scholar 

  • Kolecki P. Inadvertent methamphetamine poisoning in pediatric patients. Pediatr Emerg Care. 1998;14(6):385–7.

    Article  CAS  PubMed  Google Scholar 

  • Krifi MN, Savin S, Debray M, Bon C, El Ayeb M, Choumet V. Pharmacokinetic studies of scorpion venom before and after antivenom immunotherapy. Toxicon. 2005;45(2):187–98.

    Article  CAS  PubMed  Google Scholar 

  • Lutkin S. Arizona hospital’s $80,000 bill stings worse than scorpion venom: ABC news. 2012. Available from: 30 Apr 2017.

  • More D, Nugent J, Hagan L, Demain J, Schwertner H, Whisman B, et al. Identification of allergens in the venom of the common striped scorpion. Ann Allergy Asthma Immunol. 2004;93(5):493–8.

    Article  PubMed  Google Scholar 

  • Mowry JB, Spyker DA, Cantilena LR Jr, McMillan N, Ford M. 2013 annual report of the American Association of Poison Control Centers’ National Poison Data System (NPDS): 31st annual report. Clin Toxicol (Phila). 2014;52(10):1032–283.

    Article  Google Scholar 

  • O’Connor A, Ruha AM. Clinical course of bark scorpion envenomation managed without antivenom. J Med Toxicol. 2012;8(3):258–62.

    Article  PubMed  PubMed Central  Google Scholar 

  • Osnaya-Romero N, Acosta-Saavedra LC, Goytia-Acevedo R, Lares-Asseff I, Basurto-Celaya G, Perez-Guille G, et al. Serum level of scorpion toxins, electrolytes and electrocardiogram alterations in Mexican children envenomed by scorpion sting. Toxicon. 2016;122:103–8.

    Article  CAS  PubMed  Google Scholar 

  • Quintero-Hernandez V, Jimenez-Vargas JM, Gurrola GB, Valdivia HH, Possani LD. Scorpion venom components that affect ion-channels function. Toxicon. 2013;76:328–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rendon-Anaya M, Delaye L, Possani LD, Herrera-Estrella A. Global transcriptome analysis of the scorpion Centruroides noxius: new toxin families and evolutionary insights from an ancestral scorpion species. PLoS One. 2012;7(8):e43331.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Santibanez-Lopez CE, Francke OF, Ureta C, Possani LD. Scorpions from Mexico: from species diversity to venom complexity. Toxins. 2015;8(1).

    Google Scholar 

  • Stahnke HL. The venomous effects of some Arizona scorpions. Science. 1938;88(2277):166–7.

    Article  CAS  PubMed  Google Scholar 

  • Stahnke H. The Arizona scorpion problem. Ariz Med. 1950;7(3):23–9.

    Google Scholar 

  • Strommen J, Shirazi F. Methamphetamine ingestion misdiagnosed as Centruroides sculpturatus envenomation. Case Rep Emer Med. 2015;2015:320574.

    Google Scholar 

  • Suchard JR, Hilder R. Atropine use in Centruroides scorpion envenomation. J Toxicol Clin Toxicol. 2001;39(6):595–8; discussion 9.

    Google Scholar 

  • Therapeutics RD. Centruroides (scorpion) immune F(ab’)2 (equine) injection. 2011. Available from:

  • Vazquez H, Chavez-Haro A, Garcia-Ubbelohde W, Paniagua-Solis J, Alagon A, Sevcik C. Pharmacokinetics of a F(ab')2 scorpion antivenom administered intramuscularly in healthy human volunteers. Int Immunopharmacol. 2010;10(11):1318–24.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Anne-Michelle Ruha .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer Science+Business Media B.V., part of Springer Nature

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Ruha, AM. (2018). North American Scorpion Envenomations. In: Vogel, CW., Seifert, S., Tambourgi, D. (eds) Clinical Toxinology in Australia, Europe, and Americas. Toxinology. Springer, Dordrecht.

Download citation

Publish with us

Policies and ethics