Marine toxins, envenomations, and bites

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Background

Mechanism

  • Punctures skin to introduce venom
  • Generally local symptoms without systemic effects

Diagnosis

Symptoms

  • Vary with species
  • Generally local pain
  • Systemic symptoms can include vomiting, hypotension, muscle cramps, paralysis, cardiac arrest

Differential Diagnosis

  1. Toxins
    1. Scombroid
    2. Ciguatera
  2. Stingers
    1. Stingrays
  3. Venomous fish (catfish, zebrafish, scorpion fish, stonefish)
    1. Sea urchins
    2. cone shells
  4. Nematocysts
    1. Jellyfish (Cnidaria)
    2. Portuguese man-of-war
    3. Corals
    4. Fire Corals
    5. Sea anemones
    6. Sea wasps
  5. Bites
    1. Octopus

Treatment

  • Supportive
  • If visible remove spines and stinger
  • Immediately immerse wound in hot water (45°C for 30-90min)
  • Clean area
  • Tetanus prophylaxis
  • Antivenom exists for stonefish toxicity

Sources

  • Auerbach PS. Marine envenomations. N Engl J Med. 1991.
  • Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.
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