Insect stings, scorpion stings and spider bites

T63.2/3/4 + External Cause Code (V,W,X,Y)

Poisons Information Helpline:0861555777
See Exposure to poisonous substances .

DESCRIPTION

Injury from spider bites and stings by bees, wasps, scorpions and other insects.

Symptoms are usually local such as pain, redness swelling and itching.

Bees and wasps

  • Venom is usually mild but may provoke severe allergic reactions such as laryngeal oedema or anaphylaxis (see Anaphylaxis).

Spiders and scorpions

  • Most are non-venomous or mildly venomous, but some may be extremely venomous and constitute a medical emergency.

MEDICINE TREATMENT

Emergency treatment:

Treat anaphylaxis (bee/wasp stings). See Section Anaphylaxis

Severe local symptoms:

Children

  • Chlorphenamine, oral, 0.1 mg/kg/dose 6–8 hourly. See paediatric dosing tool.

CAUTION
Do not give an antihistamine to children < 2 years of age.

Adults

  • Chlorphenamine, oral, 4 mg, 6–8 hourly.

AND

  • Calamine lotion, applied when needed.

If hypersensitivity response to insect bite with inflamed lesion, see Papular urticaria .

Pain:

Children

  • Paracetamol, oral, 10–15 mg/kg/dose 6 hourly when required. See paediatric dosing tool.

Adults

  • Paracetamol<, oral, 1 g 4–6 hourly when required.
    • Maximum dose: 15 mg/kg/dose.
    • Maximum dose: 4 g in 24 hours.

Cytotoxic lesions:

Avoid giving prophylactic antibiotics for bites and stings.
If secondary skin infection (site red, swollen, hot, tender, pus may be present), manage as cellulitis. See Cellulitis .

Very painful scorpion stings:

  • Lidocaine 2%, 2 mL injected around the bite as a local anaesthetic. Local application of ice if tolerated.

For spider bites and scorpion stings: Tetanus prophylaxis: Z23.5

If not immunised within the last 5 years:

  • Tetanus toxoid vaccine (TT), IM, 0.5 mL.

LoEIII [22]

REFERRAL

  • For possible antivenom (neurotoxic spider bites or scorpion stings), if applicable, and intensive care, if necessary.
  • Presence of systemic manifestations:
    • weakness
    • drooping eyelids
    • hypersalivation
    • sweating
    • difficulty in swallowing and speaking
    • double vision
    • muscle cramps
    • paraesthesia
    • difficulty in breathing
    • agitation/restlessness in children

Note: Send the spider or scorpion with the patient, if available.

  • If secondary infection of bite/sting present, that is not responding to first line antibiotics.