Clinical Toxinology Resources Home
 
 
 
Tityus serrulatus
General Details, Taxonomy and Biology, Venom, Clinical Effects, Treatment, First Aid , Antivenoms
Tityus serrulatus  [ Original photo copyright © Dr Julian White ]
Family: Buthidae
Genus: Tityus
Species: serrulatus
Region
South America
Countries
Brazil
 
Taxonomy and Biology
Adult Length ( mm ): 60 to 70 mm
Description
The cephalothorax and tergites I to VI are yellowish brown. Last tergite, tail segments, legs, pedipalps and chelicerae are pale yellow. Ventral side of the 5th caudal segment is blackish.
Species Map
Small (Approx 20k) version
 
Venom
General: Venom Neurotoxins
Excitatory neurotoxins (for Tityus serrulatus stings; applicability to other Tityus species uncertain).
General: Venom Myotoxins
Not present
General: Venom Procoagulants
Not present
General: Venom Anticoagulants
Not present
General: Venom Haemorrhagins
Not present
General: Venom Nephrotoxins
Not present
General: Venom Cardiotoxins
Primary cardiotoxin
General: Venom Necrotoxins
Not present
General: Venom Other
Not present or not significant
 
Clinical Effects
General: Dangerousness
Severe envenoming possible, potentially lethal in children (at least for Tityus serrulatus).
General: Rate of Envenoming: Unknown; most stings likely to cause at least local envenoming (for Tityus serrulatus stings; applicability to other Tityus species uncertain).
General: Untreated Lethality Rate: 0.28% overall, but 1% in children under 14 yrs age (for Tityus serrulatus) even with antivenom treatment
General: Local Effects
Local pain & swelling (for Tityus serrulatus stings; applicability to other Tityus species uncertain).
General: Local Necrosis
Does not occur, based on current clinical evidence
General: General Systemic Effects
Vomiting (nearly all cases), tachycardia, tachypnoea, sweating, restlessness, somnolence, hyper- or hypothermia, hypertension (for Tityus serrulatus stings; applicability to other Tityus species uncertain).
General: Myotoxicity
Direct myotoxicity does not occur.
General: Coagulopathy & Haemorrhages
Does not occur, based on current clinical evidence
General: Renal Damage
Does not occur, based on current clinical evidence, except rarely as a secondary effect of poor cardiac output or cardiac arrest (for Tityus serrulatus stings; applicability to other Tityus species uncertain).
General: Cardiotoxicity
Systemic envenoming can cause primary cardiotoxicity, with tachycardia or (less commonly) bradycardia, hypertension, cardiac arrhythmias, heart failure, cardiac arrest (about 5% of paediatric cases) (for Tityus serrulatus stings; applicability to other Tityus species uncertain).
General: Other
A wide variety of other symptoms may occur infrequently (for Tityus serrulatus stings; applicability to other Tityus species uncertain).
 
First Aid
Description: First aid for scorpion stings (in areas where potentially dangerous species may be found)
Details
1. After ensuring the patient and onlookers are not at risk of further scorpion stings, the victim should be reassured and persuaded to lie down and remain still. Some may be terrified, fearing sudden death and, in this mood, they may behave irrationally or even hysterically, a situation made worse by the intense pain often suffered. The basis for reassurance is the fact that most scorpion stings prove non-lethal and the effectiveness of modern medical treatment.
2. The sting wound should not be tampered with in any way. Wiping it once with a damp cloth to remove surface venom is unlikely to do much harm (or good) but the wound must not be massaged.
3. Though unproven, there is anecdotal evidence suggesting the application of a cold pack to the sting area may reduce pain. At least in Mexico, there is also anecdotal evidence suggesting local suction may be beneficial.
3. All rings or other jewellery on the bitten limb, especially on fingers, should be removed, as they may act as tourniquets if swelling develops.
4. The bitten limb should be immobilised as effectively as possible using an extemporised splint or sling; if available, crepe bandaging of the splinted limb is an effective form of immobilisation.
5. If there is any impairment of vital functions, such as problems with respiration, airway, circulation, heart function, these must be supported as a priority. In particular, for bites causing flaccid paralysis, including respiratory paralysis, both airway and respiration may be impaired, requiring urgent and prolonged treatment, which may include the mouth to mask (mouth to mouth) technique of expired air transfer. Seek urgent medical attention.
6. Do not use Tourniquets, cut, suck or scarify the wound or apply chemicals or electric shock.
7. Avoid peroral intake, absolutely no alcohol. No sedatives outside hospital. If there will be considerable delay before reaching medical aid, measured in several hours to days, then give clear fluids by mouth to prevent dehydration.
8. If the offending scorpion has been killed it should be brought with the patient for identification.
9. The scorpion sting victim should be transported as quickly and as passively as possible to the nearest place where they can be seen by a medically-trained person (health station, dispensary, clinic or hospital). The bitten limb must not be exercised as muscular contraction will promote systemic absorption of venom. If no motor vehicle or boat is available, the patient can be carried on a stretcher or hurdle, on the pillion or crossbar of a bicycle or on someone's back.
10. Most traditional, and many of the more recently fashionable, first aid measures are useless and potentially dangerous. These include local cauterization, incision, excision, amputation, injection or instillation of compounds such as potassium permanganate, phenol (carbolic soap) and trypsin, application of electric shocks or ice (cryotherapy), use of traditional herbal, folk and other remedies including the ingestion of emetic plant products and parts of the snake, multiple incisions, tattooing and so on. The role of suction by mouth, vacuum pump or syringe, combined incision and suction ("venom-ex" apparatus) is uncertain.

 
Treatment
Treatment Summary
Little or no information available for stings by most Tityus species. The following is based on experience treating envenoming by the potentially lethal species, Tityus serrulatus in Brazil: Stings in adults usually cause only local effects, requiring symptomatic treatment only, which may include local anaesthesia.
Children under 14 years of age are at risk of more severe envenoming, including potentially lethal systemic envenoming. Children should be admitted, and in virtually all cases given IV antivenom on presentation, followed by symptomatic treatment, as indicated, which may include local anaesthesia ± dipyrone for pain, antiemetic such as metoclopramide IV for vomiting, furosemide & oxygen ± intubation & ventilation for pulmonary oedema, lidocaine IV for ventricular tachycardia, prazosin or phenoxybenzamine for severe hypertension, dopamine or similar for circulatory shock, but avoid beta blockers and use atropine, with great caution, only to manage severe bradycardia.
Key Diagnostic Features
Local pain, sometimes swelling, in children, systemic envenoming with vomiting, tachycardia, tachypnoea, sweating, less commonly pulmonary oedema, cardiac arrhythmias or arrest. (Based on Tityus serrulatus stings; data lacking for most other Tityus species)
General Approach to Management
Stings to adults, though often painful requiring symptomatic care, are unlikely to cause major envenoming. Admission may not be warranted. All children under 14 years age are at substantial risk and should be admitted, at least overnight. Some experts (Brazil) recommend IV antivenom on presentation for all paediatric cases. (Based on Tityus serrulatus stings; data lacking for most other Tityus species)
Antivenom Therapy
Antivenom therapy for scorpion stings remains controversial. However, in Brazil, routine use of IV antivenom in all paediatric cases of Tityus serrulatus stings, at presentation, is recommended by local experts.
Antivenoms
1. Antivenom Code: IAmIBB01
Antivenom Name: Soro antiarachnidico
Manufacturer: Instituto Butantan
Phone: +55-11-3726-7222
Address: Av. Vital Brasil, 1500 Butanta
05503-900
Sao Paulo - SP
Country: Brazil
2. Antivenom Code: IAmIBB02
Antivenom Name: Soro antiscorpionico
Manufacturer: Instituto Butantan
Phone: +55-11-3726-7222
Address: Av. Vital Brasil, 1500 Butanta
05503-900
Sao Paulo - SP
Country: Brazil
3. Antivenom Code: IAmFED06
Antivenom Name: Soro Anti-Scorpion
Manufacturer: Fundacao Ezequiel Dias - FUNED
Phone: ++55-31-3371-9525
Address: Rua Conde Pereira Carneiro, 80 - Gameleria
Belo Horizonte, MG - CEP 30510-010
Country: Brazil
4. Antivenom Code: IAmCBV02
Antivenom Name: Suero Antiescorpionico y Antiofidico polyvalente
Manufacturer: Centro de Biotecnologia
Phone: ++58-212-605-2704
Address: Faculta de Farmacia,
Universidad Central de Venezuela
Av. Principal de Los Llustres
Los Caguaramos
Caracas,
Country: Venezuela
Tityus serrulatus [ Original photo copyright © Dr Julian White ]
Larger version
 
Tityus serrulatus [ Original photo copyright © Dr Wolfgang Wuster ]
Larger version
 
Find a Reference
Reference Number: