23 May 2012

Barefoot in scorpion land

A near-fatal scorpion sting on the toe tends to really drive the message home: always wear closed shoes in the bush…


Niko Brummer was one of those South African kids who grew up honoring the fine local tradition of going barefoot whenever possible. And in Niko’s case, he saw no reason to start wearing shoes just because he’d reached adulthood. But a near-fatal scorpion sting on the toe tends to really drive the message home: always wear closed shoes in the bush…

Niko, an engineer from Somerset West near Cape Town, remembers his encounter with the arachnid in – agonizing – detail.

He was camping with some friends in northern Namibia near the Epupa Falls on the Cunene River.

“One night I was walking around barefoot, when I felt a sharp pain in my little toe. I saw the scorpion scuttling away – it was yellowish-brownish, and about as big as my thumb – so there was no doubt what had caused it."

Like 1000 bee stings
“The pain was bad – very bad, like 1000 bee stings. We tried to cauterize the sting, but that didn’t help; the pain from the fire was almost a relief compared to the sting! One of my friends (my dive partner) tried sucking the poison out. We also tried bandaging and unbandaging the foot, and I drank some sugar-water.”

None of these methods was the least bit of help, however, and after a few minutes Niko started experiencing additional symptoms.

“I felt a tingling in my skull. Then I started losing control over my muscles – I couldn’t stand. And I got uncontrollable muscular spasms, including spasms in my diaphragm, making it hard to breathe.

“Also – and this was one of the worst symptoms – my bladder wouldn’t open. As it got fuller it started encroaching on my lungs.”

Nightmare plane ride
Fortunately, Niko’s friends were able to borrow a radio from a group of engineers who were also in the vicinity to investigate dam construction near the Epupa Falls.

The availability of a radio, says Niko, was a real stroke of luck. “It was also lucky that we’d taken out medical insurance that covered an emergency air lift!”

“So at about 10 o’clock that night we tried to radio for a plane to get medical assistance, but it took a long time to make contact. Making successful radio contact depends on the atmospheric conditions and whether someone is awake on the other side. Eventually we did get through and the plane arrived.”

But Niko’s saga wasn’t over; the plane ride took much longer than expected, and was excruciatingly uncomfortable: “After we took off for Windhoek, we had to land on the way to get more fuel. The bumping each time we took off and landed made the spasms worse and very painful. The medic on the plane injected me with a salt solution, but I think he gave me too much, and he inserted a catheter – but this actually worsened the bladder problem. And it was getting harder to breathe.”

Hospital ordeal
“We finally got to the hospital at about three o’clock in the afternoon of the next day. I’d survived one bad night, but I still had to survive a second: in hospital. The care I got at the hospital wasn’t great: there was no place for me in intensive care.

“They removed the catheter, and blood spurted out because my urethra had been damaged. My lungs were also x-rayed. The pulse oximeter [measures blood oxygen levels] they put on my ear fell off during the night, and no-one came to check on me when that happened. I managed to put it back with the little bit of muscular control I still had in my hands.

"Also, the drip that was set up in my hand wasn’t inserted properly, and there seemed to be some blockage in my veins. Later, after I’d recovered, I lost control of my hand when I went spearfishing one time, and couldn’t grip the fish – but I’m not sure if that was an after-effect of the drip or the sting.

“The treatment I got was just supportive: I was given salt solutions and antibiotics, but no anti-venom. It took about 40 hours or so from the time of the sting until the effects of the venom began to subside. But my little toe and part of my foot felt numb for about three months afterwards.”

Niko’s sister, Willemien Brummer, says that one of the reasons Niko survived was because he was fit from spearfishing: “The doctor said that he had very strong lungs, which may have saved him. There was a point when we weren’t sure he was going to make it; the doctor called my parents in Cape Town and suggested they fly up to Windhoek – essentially to say good-bye.”

What stung Niko?
It is likely that Niko was stung by a member of the highly venomous Parabuthus genus, quite possibly Parabuthus granulatus*. Dr Gerbus Muller, a toxicologist and scorpion expert at Tygerberg Hospital, says that, although serious stings are rare, Parabuthus can be deadly, and is especially dangerous for children, for whom it is fatal in about 20% of cases.

Respiratory support is crucial
Treatment for a serious scorpion sting, says Dr Muller, involves getting the patient on respiratory support as soon as possible: “Respiratory complications are the major threat – they can be fatal.”

Anti-venom is also usually administered, but, says Dr Muller, “It takes quite a while for it to take effect – about three to six hours – so it isn’t sufficient to prevent respiratory complications.” Recovery from a sting without anti-venom is a much more drawn-out process.

Dr Muller does not recommend any of the methods tried by Niko’s companions, nor does he recommend taking anti-venom on trips to remote areas. “This tends to give people a false sense of security. And there may be complications, such as allergy, with using anti-venom in some cases. Only someone specifically trained to treat scorpion stings should attempt to do so.”

- Olivia Rose-Innes, EnviroHealth Editor, Health24, updated July 2011


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