Clinical recognition Bites are seldom mistaken if the child is old enough to describe the spider There is generalized pain and rigidity of muscles to hours after the bite, typically without local symptoms The pain is cramping and felt in the abdomen, flanks, thighs, and chest Nausea and vomiting are often reported in children Respiratory distress, chills, urinary retention, tachycardia, hypertension, myocarditis and priapism can occur Patients might become anxious and report generalized diaphoresis and flushing There is a 4% to 5% mortality rate, with death resulting from cardiovascular collapse The mortality rate in young children may be as high as 50% if untreated The syndrome after a black widow spider bite may easily confuse the clinician as it mimics many medical or surgical conditions such as myocardial infarction, alcohol/opiate withdrawal, organophosphate poisoning, acute abdomen, rabies, tetanus, renal colic, food poisoning, or Staphylococcal sepsis TABLE 90.20 GRADING SCALE FOR LATRODECTUS ENVENOMATION Grade Symptoms Asymptomatic Local pain at bite site Normal vital signs Muscular pain—localized Diaphoresis—localized Normal vital signs Muscular pain—generalized Abnormal vital signs Nausea, vomiting Headaches Diaphoresis Management A child who has severe pain and muscle rigidity after a spider bite should be considered a Latrodectus bite victim A clinical grading scale has been developed by Clark ( Table 90.20 ) Local treatment of the site of the bite with the use of a tourniquet or with incision and suction of the venom has not proven beneficial Treatment with Latrodectus antivenin (Lyovac, Merck, Sharp