Common scorpions by region and potential toxicity*

For assistance in managing a patient with a suspected scorpion envenomation, contact a regional poison control center (in the United States, call 1-800-222-1222).
Region	Scorpion species	Clinical manifestations	RCTs in humans show antivenom reduces duration and severity of symptoms?
North Africa	Androctonus Buthus Leiurus	Autonomic storm Myocardial depression Pulmonary edema	No
Middle East (including Turkey, Iran, and Lebanon) Israel	Leiurus Androctonus	Autonomic storm Cardiac dysfunction Pulmonary edema Acute pancreatitis	No
Asia	Hottentotta (Mesobuthus, India, Pakistan, and Sri Lanka) Androctonus	Autonomic storm Myocardial depression Pulmonary edema	Yes
Asia	Hemiscorpius (Iran)	Local tissue necrosis, rarely hemolysis and acute kidney injury	No
South America Caribbean (Trinidad)	Tityus	Autonomic storm Myocardial depression Pulmonary edema Acute pancreatitis	No
Central America, Mexico, and southwestern United States	Centruroides	Autonomic signs (primarily parasympathetic) Neuromuscular toxicity	Yes
Central America, Mexico, and southwestern United States	Tityus (Central America only)	As above	Yes
Southern Africa	Parabuthus	Autonomic signs (primarily parasympathetic) Neuromuscular toxicity	No

Autonomic storm occurs after stings of "Old World" scorpions that inhabit North Africa, the Middle East, Asia, and South America. It manifests as a combination of:

Parasympathetic signs: Salivation, lacrimation, vomiting, diarrhea, bronchorrhea, bronchospasm, diaphoresis, bradycardia, hypotension, miosis, and priapism.
Sympathetic signs: Tachycardia, hypertension, agitation, dilated pupils, and hyperthermia.
Cardiac conduction abnormalities arise from the combined autonomic effects and occur in up to half of patients. They include atrial tachycardia, preventricular contractions, T-wave and ST-T wave changes, and bundle branch block.
Myocardial depression is caused by the autonomic disturbance and can progress to cardiogenic shock with pulmonary edema.

Parasympathetic findings are present for the first few hours after an "Old World" scorpion sting; sympathetic effects and myocardial depression persist.

Neuromuscular toxicity follows stings by "New World" scorpions that live in Mexico, Central America, Western and Southern Africa, and parts of the United States. Findings consist of:

Cranial nerve dysfunction with slurred speech, dysphagia, drooling, tongue fasciculations, blurred vision, and abnormal eye movements (eg, conjugate, roving, slow and involuntary motion with multidirectional conjugate saccades [similar to opsoclonus] and unsustained primary positional nystagmus).
Somatic skeletal muscle dysfunction appearing as undulating and writhing restlessness, fasciculations, extremity shaking and jerking, opisthotonos (arching of the back), and emprosthotonos (tetanic forward body flexion) with preservation of alertness.

RCT: randomized controlled trials.
* Envenomation with systemic effects occur in approximately one-third of stings. With the exception of stings by Hemiscorpius lepturus, all of these scorpion stings are associated with local pain and paresthesias. Refer to UpToDate topics on scorpion stings for further discussion of clinical manifestations, diagnosis, and treatment of scorpion stings.

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Common scorpions by region and potential toxicity*