Marine toxins, envenomations, and bites

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

Marine toxins, envenomations, and bites

• Toxins
  • Ciguatera
  • Scombroid
  • Tetrodotoxin (e.g. pufferfish)
  • Shellfish poisoning
    • Amnesic shellfish poisoning
    • Diarrheal shellfish poisoning
    • Neurotoxic shellfish poisoning
    • Paralytic shellfish poisoning
• Stingers
  • Stingray injury
• Venomous fish
  • Cone shell
  • Lionfish
  • Sea urchins
  • Crown-of-Thorns Starfish
  • Stonefish
  • Other: Catfish, zebrafish, scorpion fish
• Nematocysts
  • Coral reef
  • Fire coral
  • Jellyfish (Cnidaria)
    • Box jellyfish
      • Irukandji syndrome
    • Sea wasp
  • Portuguese man-of-war
  • Sea anemones
  • Seabather's eruption
• Phylum porifera (sponges)
• Bites
  • Alligator and crocodile attacks
  • Octopus bite
  • Shark bite
• Infections
  • Vibrio species in saltwater
  • Aeromonas species in freshwater

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.