What is the role of lab studies in the workup of scorpion envenomation?

Updated: Nov 09, 2018
  • Author: David Cheng, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Answer

Scorpion envenomation cases vary from those requiring no laboratory tests to scenarios requiring extensive hematologic, electrolyte, and respiratory analysis.

Obtain a CBC count, as Hemiscorpius lepturus has been shown to cause severe hemolysis. In addition, marked leukocytosis suggests induction of a venom-mediated systemic inflammatory response‒like syndrome.

Electrolyte evaluation is warranted in patients with venom-induced salivation, vomiting, and diarrhea.

Coagulation parameters should be measured for venom-induced defibrination because, at high concentrations, the venom is an anticoagulant. Defibrination syndrome has been reported following Mesobuthus tamulus stings.

Glucose levels should be measured to evaluate for hyperglycemia from liver and pancreas dysfunction.

Troponin and NT-proBNP elevation suggests myocarditis.

Creatine kinase and urinalysis help evaluate for venom-induced excessive motor rhabdomyolysis. Renal failure may occur secondary to hemoglobinuria from hemolysis (after H lepturus sting) or myoglobinuria from rhabdomyolysis

Obtain amylase/lipase values to assess for pancreatitis, which is common, from Tityus trinitatis stings.

Patients may have increased aspartate aminotransferase and alanine aminotransferase levels from venom-induced liver cell destruction.

Increased catecholamine, aldosterone, renin angiotensin, and antidiuretic hormone levels are detected a few hours after the sting. The increased levels persist for 6 hours, after which a gradual decline occurs.

Obtain arterial blood gas (ABG) measurements as indicated for respiratory distress or to determine acid/base status.

Additional laboratory abnormalities that may have research relevance include interleukin (IL)–1 levels, which have been reported to be elevated.

High levels of IL-6, interferon-gamma, and granulocyte-macrophage colony-stimulating factor are reported in severe envenomations.

Radiolabeled antibodies or immunoenzymatic assays help quantify the serum venom level because an association exists between the clinical signs of envenomation and this level. [29]  However, it is rarely used, owing to cost and because clinical grading is as effective. It is most likely only used as a research tool.


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