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SCORPION

PHARMACEUTICAL TOXICOLOGY (LEC) • Centruroides vittatus (striped bark scorpion) .

ENVENOMATION
TOPIC OUTLINE

I. INTRODUCTION
II. ARTHROPODS
III. ARACHNIDS
IV. CHILOPODA
V. DIPLOPODA
VI. REPTILES
VII. INSECTA

• Centruroides vittatus, the striped bark scorpion, is commonly

ENVENOMATION
• Envenomation is the exposure to a poison or toxin resulting from
a bite or sting from an animal such as a snake, scorpion, spider,
or insect, or from marine life.
ARTHROPODS
• Arthropods are invertebrates with jointed legs. Many species of
the phylum Arthropoda are capable of exuding toxins, of injecting
venom through a stinger or fangs, or of causing mechanical
damage by biting or pinching.
• These include the:
o Arachnids (scorpions, spiders, whip scorpions, solpugids,
mites, and ticks)
o Myriapods (centipedes and millipedes)
o Insects (water bugs, assassin bugs, and wheel bugs)
o Beetles (blister beetles)
o Lepidoptera (butterflies, moths, and caterpillars)
o Hymenoptera (ants, bees, and wasps)
• Any arthropod may bite or sting and not eject venom. Often,
anticoagulants and enzymes contained in arthropod saliva cause
pain, localized irritation, and (sometimes potentially fatal) allergic
reactions, with arthropod venom capable of affecting cellular and
nervous functions.
ARACHNIDS
• The term arachnid refers to a class of animals that includes spiders,
scorpions, mites, and ticks.
• Most arachnids have a segmented body divided into two regions,
with the front part bearing four pairs of legs, but no antennae
involved in envenomation but fatalities are rare. In their review of
Centruroides sculpturatus stings, noted visual signs, including
nystagmus roving eye and oculogyric movements, in 12 of 24
patients stung by this scorpion.
• Scorpion venom may contain multiple toxins and other compounds.
The venom is composed of varying concentrations of neurotoxin,
cardiotoxin, nephrotoxin, hemolytic toxin, phosphodiesterases,
phospholipases, hyaluronidases, glycosaminoglycans, histamine,
serotonin, tryptophan, and cytokine releasers.
MECHANISM OF POISONING:
• Scorpion venom stimulates the autonomic nervous system,
predominantly the sympathetic, which leads to sudden liberation of
endogenous catecholamine resulting in an early transient rise in
blood pressure, bradycardia, and increased vascular resistance.
CLINICAL MANIFESTATION:
• In children, their sting may produce initial pain, although some
children do not complain of pain and are unaware of the injury.
• The area becomes sensitive to touch, and merely pressing lightly
over the injury will elicit an immediate retraction. Usually there is
little or no local swelling and only mild erythema.
DIAGNOSIS:
• Diagnosis of a scorpion sting is obvious from the history.
Determining the scorpion species is usually not. Several species of
scorpions kept as exotic pets in the US are similar in appearance
to foreign species with dangerously toxic venom.
TREATMENT OF POISONING:

• bed rest
• benzodiazepines for muscle spasms
• IV drugs as needed to control hypertension, agitation, and pain.

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SPIDER
• Mature Latrodectus mactans females range in body length from10
to 18 mm, whereas males range from 3 to 5 mm (Fig. 26-22).
CHILOPODA (CENTIPEDES
• These elongated, many-segmented brownish-yellow arthropods
have a pair of walking legs on most segments, and they are fast
moving, secretive, and nocturnal
• The first pair of legs behind the head is modified into poison jaws.
• Prevalent biting genus is a Scolopendra species.

• Spider venoms are a cocktail of many chemicals. • Centipede venoms contain high-molecular-weight proteins,
• Some are neurotoxins, which evolved to kill or immobilise proteinases, esterases, 5-hydroxytryptamine, histamine, lipids, and
arthropods like insects by attacking their nervous systems; others polysaccharides
are cytotoxins which help break down the tissue so the spider can
ingest a liquefied meal.
MECHANISM OF POISONING
MECHANISM OF POISONING:
• The bite produces two tiny punctures, centipede venom toxins
• These venom components cause coagulation of blood and, selectively bind Kv2.1 channels and block them. Centipede venom
ultimately, the occlusion of small blood vessels at the bite site. This disrupts cardiovascular, respiratory, muscular and nervous systems
leads to local skin and tissue necrosis due to ischemia. Hemolysis by targeting the broadly distributed Potassium Voltage-Gated
Channel Subfamily Q (KCNQ) channels.
of red blood cells may also occur.
CLINICAL MANIFESTATIONS
CLINICAL MANIFESTATION:
• Sharp pain
• Muscle fasciculations frequently can be seen within 30 minutes of • Swelling often lasting 24 hours
the bite. • Necrosis
• bite site lesion and pain, abdominal pain and tenderness, and lower • Nausea
extremity pain and weakness within minutes to hours of • Vomiting
envenomation. Symptoms progress over several hours, then • Changes in heart rate
subside over 2 to 3 days. • Vertigo
• Headache
DIAGNOSIS: • Allergies
• Anaphylactic shock
• Spider bites are often falsely suspected by patients. Diagnosis is
typically suspected based on history and physical signs, but TREATMENT / MANAGEMENT
confirmation is rare because it requires witnessed biting,
identification of the spider (the spider is rarely recovered intact), and • Apply heat to the bite as quickly as possible. Immersing the wound
exclusion of other causes. in hot water or using hot compresses dilutes venom.
• Ice packs can be used to reduce swelling.
• Use medications to reduce pain, allergic reactions, and
TREATMENT OF POISONING:
inflammation. These include antihistamines, anesthetics, and anti-
inflammatory drugs.
• Clean the wound with mild soap and water.
• To avoid infection, use a topical antibiotic and keep the site clean
• Apply a cool compress over the bite for 15 minutes each hour.
and covered.
• If possible, elevate the affected area.
• Take an over-the-counter pain reliever as needed.
• If the wound is itchy, an antihistamine might help

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DIPLOPODA (MILLIPEDES)
• These arthropods are cylindrical, worm-like creatures, mahogany
to dark brown or black in color, and bearing two pairs of jointed legs
per segment.
• In Australia and New Guinea particularly, the repellent secretions
expelled from the sides of their bodies contain a toxin of
benzoquinone derivatives plus a variety of complex substances
such as iodine and hydrocyanic acid, which the animal makes use
of to produce hydrogen cyanide.
MECHANISM OF POISONING
• Millipedes are unable to inject venom, instead employ defensive
mechanisms by curling up in a ball and secreting irritating
chemicals from micropores along their sides to deter predators.
CLINICAL MANIFESTATIONS
• Burning or prickling sensation
• Development of yellowish or brown - purple lesion
• A blister containing serosanguinous fluid forms, which may rupture.
• Eye contact can cause acute
• conjunctivitis, periorbital edema, keratosis
TREATMENT / MANAGEMENT
• Toxic secretions of millipedes should be washed from the skin with
large amounts of soap and water.
• If a skin reaction develops, a corticosteroid cream should be applied.
• Eye injuries should be flushed with water (irrigated) immediately.
MOLLUSCA (CONE SNAILS)
• The genus Conus is a group of approximately 500 species of
carnivorous predators found in marine habitats that use venom as a
weapon for prey capture
• Cone snails have a venom duct for synthesis and storage of venom
and hollow harpoon-like teeth for injection of the venom
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MECHANISM OF POISONING
• “lightning-strike cabal”
o causes immediate immobilization of the injected prey
because various venom components inhibit voltage
gated sodium channel inactivation and block potassium
channels, resulting in massive depolarization of axons in
the vicinity of the injection site and a tetanic state.
• “motor cabal,”
o acts more slowly as conotoxins must be distributed
throughout the body of the prey. The overall result is total
inhibition of neuromuscular transmission.
SIGNS AND SYMPTOMS
• Pain, swelling and numbness at sting site. The venom causes
prolonged weakness of muscles, including the muscles of
respiration (breathing), and disturbance of vision, speech and
hearing.
TREATMENT / MANAGEMENT
• Pressure immobilization, using a broad pressure bandage and
splint, is recommended.
• Stay with the person, reassure them and keep them still.
• Prolonged artificial respiration, even mechanical ventilation, may be
required.
• At this stage, there is no antivenom available for cone shell stings.
• A tetanus injection may also be needed in case the wound is
contaminated.
REPTILES
• Venomous reptiles are distributed in select habitats in temperate
and tropical areas of the world with few geographical exceptions,
and have adapted to not only terrestrial existence, but to arboreal
and aquatic environments as well. Some of these reptiles are
Snakes and Lizards.
LIZARDS
The Gila monster (Heloderma suspectum)
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Beaded lizards (Heloderma horridum)

The Gila monster The Mexican beaded lizard

(pronounced HEE-luh) is a
small, striking lizard with
black scales and an array of
orange stripes and spots.
Along with their close cousins,
the beaded lizards, Gila
monsters belong to one of the
only families of venomous
lizards on Earth. Unlike most snakes and spiders, which inject their
venom using long fangs that function like hypodermic needles, Gila
monster venom is wicked up from glands on the lower jaw by tiny
grooves on each tooth. This means that to really envenomate their
victims, the Gila monster actually has to clamp down and then chew.
(Heloderma horridum) is a
species of lizard in the family
Helodermatidae, one of the
two species of venomous
beaded lizards found
principally in Mexico and
southern Guatemala. It and
its congener (member of the
same genus) the Gila
monster (Heloderma suspectum) are the only lizards known to have
evolved an overt venom delivery system. The Mexican beaded lizard is
larger than the Gila monster, with duller coloration, black with yellowish
bands.

MECHANISM OF POISONING: MECHANISM OF POISONING:

• The venom of the gila monster (Heloderma suspectus) contains
exendin-3 and exendin-4, two peptides that stimulate insulin
secretion in response to increases in glycemia and modulate gastric
emptying to slow the entry of ingested sugars in the blood. Rather
than injecting venom through hollow fangs like venomous snakes,
Gilas have enlarged, grooved teeth in their lower jaw. When they
bite, their powerful jaws chew the venom in through capillary action
along the grooves in these teeth.
• The bite is usually forceful and inflicts injury and serious pain. Once
the Gila latches on, it chews on the site, releasing venom along the
grooves in its teeth into the now open wound. It generally does not
release its painful hold until it feels that it is no longer in danger.
CLINICAL MANIFESTATIONS:
• Same with the Gila Monster (Heloderma suspectum).

CLINICAL MANIFESTATIONS: TREATMENT AND SUPPORTIVE REMEDIES:

• Talgogenia • Same with the Gila Monster (Heloderma suspectum).

• edema
SNAKES
• hypotension
• nausea • Venomous snakes primarily belong to the following families:
• vomiting Viperidae (vipers), Elapidae, Atractaspididae, and Colubridae. The
• weakness term venomous is applied when organisms bite or sting and inject
• diaphoresis. their toxins through the bite. and are composed of nearly 60% of
all snakes. The Atractaspididae family is known for burrowing into
the ground and possessing the ability to expose their fangs without
TREATMENT AND SUPPORTIVE REMEDIES: opening their mouth.
5 Most Dangerous And Deadliest Snakes In The World:
• No antivenin is commercially available. Treatment is
supportive. If not already separated from the victim in the A. Saw-Scaled Viper (Echis Carinatus)
prehospital phase, the lizard must be removed. Hypotension can
be treated with volume resuscitation. Anaphylaxis should be
treated with epinephrine. Wound care should include copious
irrigation and debridement as needed.

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Although its venom is not very potent, the Saw-Scaled Viper is
considered as one of the world’s deadliest snakes as it is believed to be
responsible for more human fatalities than all other snakes put together.
B. King Cobra (Ophiophagus Hannah)
In India, the King Cobra is not
only revered and worshipped but
also feared, as they are one of the
most venomous snakes of India.
In one bite, a King Cobra delivers
a tremendous amount of
neurotoxins that induces
paralysis. They are so fearsome
that they find themselves on
almost all lists of world’s deadliest snakes. King Cobra is dark olive or
brown in colour with black bands and white and yellow crossbands with
cream or pale yellow undersides.
C. Inland Taipan (Oxyuranus Microlepidotus)
Also known as the “fierce snake”,
the Inland Taipan is one of the
world’s most venomous snakes.
A bite from this variety of Taipan
often causes paralysis of the
victim’s nervous system and clots
the blood. It is an extremely fast
and agile snake and can strike
instantly with extreme accuracy.
D. Blue Krait (Bungarus Candidus)
Also known as the Malayan Krait,
the Blue Krait is a highly
venomous snake of the elapid
family. Its venom can paralyze
its victim’s muscular system; a
truly scary thought that has
earned this snake a place on the
list of the deadliest snakes in the
world.
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E. Black Mamba (Dendroaspis Polylepis)
The Black Mamba is the second-longest venomous snake after the King
Cobra. They are known for their large size,
quickness, and extremely potent
venom, making them one of the deadliest
snakes in the world. If they are disturbed or
cornered, Black Mambas will attack
with repeated bites. Their venom is
extremely toxic and just two drops
are reportedly enough to kill most humans. A Black Mamba’s venom
attacks both the nervous system and the heart, and most bites are fatal,
making them a feared creature in its native region, as well as one of the
most dangerous snakes in the world.
F. Philippine Cobra
• The Philippine cobra (Naja philippinensis) also called Philippine
spitting cobra or northern Philippine cobra, is a stocky, highly
venomous species of spitting cobra native to the northern regions
of the Philippines.
• The Philippine cobra is called ulupong in Tagalog, carasaen in
Ilocano, and agwáson or banákon in Cebuano.
• It is a highly venomous snake native to the northern regions of the
Philippines. It has a fairly stocky build, and adult snakes are
uniformly light to medium brown, while the juveniles tend to be a
darker brown in color. The head is elliptical, depressed, slightly
distinct from the neck with a short, rounded snout and large nostrils.
The eyes are moderate in size with dark brown and round pupils.
• The venom of the Philippine cobra is a potent postsynaptic
neurotoxin which affects respiratory function and can cause
neurotoxicity and respiratory paralysis, as the neurotoxins interrupt
the transmission of nerve signals by binding to the neuromuscular
junctions near the muscles.
ANTIVENOM:
• The Research Institute for Tropical Medicine (RITM) houses
the Purified Cobra Antivenin (PCAV), the only known effective
antidote for snakebites, specifically those caused by the
Philippine Cobra (Naja philippinensis).
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SNAKE VENOMS SIGNS AND SYMPTOMS
• A simplistic approach would group toxin components as
neurotoxins, coagulants, hemorrhaging, hemolytics, mycotoxins,
cytotoxins, and nephrotoxins. Neurotoxins produce neuromuscular
paralysis ranging from dizziness to ptosis; to ophthalmoplegia,
flaccid facial muscle paralysis, and inability to swallow; to paralysis
of larger muscle groups; and finally to paralysis of respiratory
muscles and death by asphyxiation. Myotoxins can directly affect
muscle contraction leading to paralysis or cause rhabdomyolysis or
the breakdown of skeletal muscle. Myoglobinuria, or a dark brown
urine, and hyperkalemia may be noted
SNAKEBITE TREATMENT:
Antivenom is the treatment for serious snake envenomation. The sooner
antivenom can be started, the sooner irreversible damage from venom
can be stopped. Driving oneself to the hospital is not advised because
people with snake bites can become dizzy or pass out.
Three general principles for every bite should be kept in mind:
(1) snake venom poisoning is a medical emergency requiring
immediate attention and the exercise of considerable judgment;
(2) the venom is a complex mixture of substances of which the
proteins contribute the major deleterious properties, and the only
adequate antidote is the use of specific or polyspecific antivenom;
and
(3) not every bite by a venomous snake ends in an envenomation.
ANTIVENOM:
Antivenom acts to neutralize the poisonous venom of the cobra and
causes the venom to be released from the receptor site. Thus, the
receptor sites that were previously blocked by venom are now free to
interact with the acetylcholine molecule, and normal respiration resumes.
The spent antivenom and the neutralized venom are then excreted from
the body.
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INSECTA
I . HETEROPTERA (TRUE BUGS)
• The clinically most important of the true bugs are the Reduviidae:
the kissing bug, assassin bug, wheel bug, or cone-nose bug of the
genus Triatoma Generally, they are parasites of rodents and
common in the nests of wood rats or in wood pile. The venom of
these bugs appears to have apyrase activity and to lack 5-
nucleotidase, inorganic pyrophosphatase, phosphatase, and
adenylate kinase activities. It inhibits collagen-induced platelet
aggregation.
SIGNS AND SYMPTOMS
• Erythema
• Pruritus
• Increased temperature
• Localize swelling.
• Nausea, Vomiting, and Angioedema
SUPPORTIVE TREATMENT/ MANAGEMENT:
No published antidote for heteropteran bites but here’s what you can do:
• Get the bug off you as quickly as possible.
• Wash the affected area with soap and water.
• Take an anti-inflammatory medicine.
• Apply an ice pack.
• Wipe a cotton ball
II. HYMENOPTERA (ANTS, BEES, WASPS, AND HORNETS)
• Formicidae (Ants) Most ant species sink their powerful mandibles
into the flesh, providing leverage, and then drive their stings into the
victim. Clinically important stinging ants are the harvesting ants
(Pagonomyrmex), fire ants (Solenopsis), and little fire ants
(Ochetomyrmex). Formicinae ant venom contains about 60%
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formic acid. Fire ant venoms are poor in polypeptides and proteins,
but are rich in alkaloids such as solenopsin.
SIGNS AND SYMPTOMS
● Painful burning sensation
● Localized erythema
● Clear vesicles turn into pustules.
In multiple stings,
● Nausea
● Vomiting
● Vertigo
● Increased perspiration
● Respiratory difficulties
● Cyanosis
● Coma and even death.
Allergic reactions and fatal anaphylactic shock are seen in sensitized
victims.
TREATMENT/ SUPPORTIVE MANAGEMENT REMEDIES:
• applying cold compresses to reduce swelling — 20 minutes on, 20
minutes off
• using a hydrocortisone cream on the skin to relieve itching.
• taking an antihistamine to manage minor, localized allergic
reactions and itching.
• applying a triple antibiotic ointment to the sting to help prevent
infection in stings opened by scratching.
• taking an oatmeal bath to reduce itching
Note: It is important to resist the urge to scratch the stings. Scratching
can open the blisters and cause infection.
Medical Treatment: Emergency treatment with epinephrine can reverse
the reaction.
• Apidae (Bees) This family includes the bumble bees, honeybees,
carpenter bees, and yellow jackets. The commonest stinging bees
are Apis mellifera and the Africanized bee, Apis mellifera adansonii,
and the incidence of Hymenoptera poisonings is increasing. In
particular, melittin tetramers cause a breakdown of the resting
potential and rapid depolarization of nociceptors, which induces
pain.
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SIGNS AND SYMPTOMS
• Sharp or burning pain
• Localized erythema
• Edema (may vary depending on the location of the sting)
• Itching
It is said that 50 stings can be serious and lead to:
● Respiratory dysfunctions
● Intravascular hemolysis
● HTN
● Myocardial damage
● Hepatic changes and shock
With 100 or more stings it will lead to DEATH.
TREATMENT/ SUPPORTIVE MANAGEMENT:
In patients who are allergic to bee stings, immediate allergic reaction with
the risk of anaphylactic shock requires urgent medical treatment.
Epinephrine for an allergic reaction.
Remedies:
o Remove any stingers right away.
o Applying ice to the site may provide some mild relief.
o Taking an antihistamine such as diphenhydramine (Benadryl)
or a nonsedating one such as loratadine (Claritin) will help with
itching and swelling.
o Take acetaminophen (Tylenol) or ibuprofen (Motrin) for pain
relief as needed.
o Wash the sting site with soap and water
• Vispidae (Wasps) This family includes wasps and hornets. These
venoms contain a high content of peptides, which include
mastoparan in wasps and hornets and crabolin from hornet venom.
These peptides release histamine from mast cells and consist of 13
to 17 amino acids with no disulfide bridges.
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SIGNS AND SYMPTOMS IMPOTANCE OF VENOM IN PHARMACOLOGY

• Immediate pain • In fact, venoms are complex mixtures of enzymatic and non-
• Increased vascular permeability leading to edema. enzymatic components with specific pathophysiological
functions
TREATMENT/ SUPPORTIVE MANAGEMENT: • Some toxins attack the nervous system, causing paralysis by
interfering with nerve-to-muscle communication. Others
• Same treatment and remedies for Apidae (Bees). prevent blood clotting, resulting in massive bleeding. Yet it’s
these same dangerous properties that could make them
useful. Substances that interfere with the nervous system
III. LEPIDOPTERA (CATERPILLARS, MOTHS, AND BUTTERFLIES) could make great painkillers, while blood thinning is a vital part
of treatment for heart disease.
• The urticating hairs, or setae, of caterpillars are effective defensive
weapons that protect some species from predators. The setae are
attached to unicellular poison glands at the base of each hair. Both
the larvae and the adults are capable of stinging, either by direct
contact with the setae or indirectly when the creature becomes
irritated. The toxic material found in the venom glands contains
aristolochic acids, cardenolides, kallikrein, and histamine among
other substances.

SIGNS AND SYMPTOMS:

● Bleeding diathesis (severe/fatal)

● Localized pain and itching
● Urticaria, Edema, and occasionally fever
● Lymphadenitis, and lymphadenopathy

TREATMENT/ SUPPORTIVE MANAGEMENT REMEDIES:

• Remove the toxin-laden hairs from your skin.

• Wash the skin thoroughly with soap and water.
• Apply an ice pack to reduce swelling and pain.
• Create a paste using baking soda and water and slather it on the
affected skin to reduce itching. A hydrocortisone cream also may
be used.
• Take an oral antihistamine (such as Benadryl) if the reaction to the
sting worsens.

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