A 10-year retrospective review was undertaken of patients presenting with "scorpion sting" to the Emergency Department of the King Fahad National Guard Hospital in Riyadh. The purpose of the study was 1) to assess the risk of morbidity and mortality following scorpion envenomation in the Riyadh area; 2) to define patient demographics of the study group and identify high risk groups for systemic toxicity; 3) to develop guidelines for patient management. Four hundred and thirty-four cases were studied. Local pain was the primary presenting complaint (92%). Systemic toxicity occurred in 25.6% (n=111). Anxiety-related presentations were the most common systemic symptoms (6%). Hypertension (17%) and/or tachycardia (4%) were the most common systemic signs. Only four patients (<1%) had signs of serious envenomation requiring admission. There were no deaths. The higher risk groups for systemic toxicity were identified as those with age less than eight years or greater than 30 years, with highest risk in those over 50 years, those with history of hypertension or diabetes, and patients with multiple stings. The great majority of patients can be treated with analgesia, local application of ice, and a period of observation dictated by clinical findings. The use of antivenin should be restricted to patients with signs of serious systemic toxicity only.