eMedicine Specialties > Emergency Medicine > Environmental

Cnidaria Envenomation: Follow-up

Author: G Patrick Daubert, MD, Assistant Professor, Assistant Medical Director, Sacramento Division, California Poison Control System; Director of Clinical and Medical Toxicology Education, Department of Emergency Medicine, University of California, Davis Medical Center
Contributor Information and Disclosures

Updated: Aug 18, 2008

Follow-up

Further Inpatient Care

  • Patients with significant Cnidaria envenomation may need inpatient treatment for pain relief and further supportive care. Generally, only severe Portuguese man-of-war, C barnesi, or box jellyfish stings result in rapid clinical decompensation.
  • In addition to cardiopulmonary supportive care, management should include treatment of renal consequences of rhabdomyolysis. Continuous monitoring for wound infection should take place because antibiotics are not always initially indicated.

Further Outpatient Care

  • Warn patients that recurrent episodes of urticaria might occur for as long as 4 weeks at the site of envenomation. This delayed reaction responds well with a 2-week taper of glucocorticoids.

Deterrence/Prevention

  • Prevention of jellyfish stings is best accomplished with a dive suit. A sunscreen containing jellyfish sting inhibitor is also available. The cream sting inhibitor may reduce the pain and erythema from jellyfish stings.

Complications

  • Complications of jellyfish stings include the following:
    • Wound infection
    • Rhabdomyolysis
    • Acute renal failure
    • Hemolysis
    • Pulmonary edema
    • Respiratory paralysis
    • Cardiovascular collapse
    • Death

Prognosis

  • If therapy is initiated in a timely manner for severe envenomations of Portuguese man-of-war, C barnesi (Irukandji syndrome), or box jellyfish, the prognosis remains excellent.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to rapidly remove the victim from the water
  • Failure to recognize that vinegar or hot water can reduce pain and fresh water may exacerbate pain associated with Cnidaria envenomation
  • Failure to recognize the need for tetanus prophylaxis
  • Failure to consider appropriate antibiotic coverage for marine bacterial infections such as Vibrio species
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Chanida Sintuu, MD, Allison J Richard, MD, and Jeffery R Tucker, MD, to the development and writing of this article.



More on Cnidaria Envenomation

Overview: Cnidaria Envenomation
Differential Diagnoses & Workup: Cnidaria Envenomation
Treatment & Medication: Cnidaria Envenomation
Follow-up: Cnidaria Envenomation
Multimedia: Cnidaria Envenomation
References
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References

  1. O'Reilly GM, Isbister GK, Lawrie PM, et al. Prospective study of jellyfish stings from tropical Australia, including the major box jellyfish Chironex fleckeri. Med J Aust. Dec 3-17 2001;175(11-12):652-5. [Medline].

  2. Bengtson K, Nichols MM, Schnadig V, et al. Sudden death in a child following jellyfish envenomation by Chiropsalmus quadrumanus. Case report and autopsy findings. JAMA. Sep 11 1991;266(10):1404-6. [Medline].

  3. Auerbach PS. Marine envenomations. N Engl J Med. Aug 15 1991;325(7):486-93. [Medline].

  4. Bailey PM, Little M, Jelinek GA, et al. Jellyfish envenoming syndromes: unknown toxic mechanisms and unproven therapies. Med J Aust. Jan 6 2003;178(1):34-7. [Medline].

  5. Brown CK, Shepherd SM. Marine trauma, envenomations, and intoxications. Emerg Med Clin North Am. May 1992;10(2):385-408. [Medline].

  6. Brush DE. Marine envenomations. In: Flomembaum N, Goldfrank LR, Howland MA, Lewin NA, Hoffman RS, Nelson LS. Goldfrank's Toxicologic Emergencies. 8th ed. New York, NY: McGraw-Hill; 2006:1629-1642.

  7. Burnett JW, Calton GJ. Jellyfish envenomation syndromes updated. Ann Emerg Med. Sep 1987;16(9):1000-5. [Medline].

  8. Burnett JW, Gable WD. A fatal jellyfish envenomation by the Portuguese man-o'war. Toxicon. 1989;27(7):823-4. [Medline].

  9. Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol. 2003;41(3):301-8. [Medline].

  10. Currie BJ, Jacups SP. Prospective study of Chironex fleckeri and other box jellyfish stings in the "Top End" of Australia's Northern Territory. Med J Aust. Dec 5-19 2005;183(11-12):631-6. [Medline].

  11. Fenner PJ, Hadok JC. Fatal envenomation by jellyfish causing Irukandji syndrome. Med J Aust. Oct 7 2002;177(7):362-3. [Medline].

  12. Fenner PJ, Williamson J, Callanan VI, et al. Further understanding of, and a new treatment for, "Irukandji" (Carukia barnesi) stings. Med J Aust. Dec 1-15 1986;145(11-12):569, 572-4. [Medline].

  13. Fenner PJ, Williamson JA. Worldwide deaths and severe envenomation from jellyfish stings. Med J Aust. Dec 2-16 1996;165(11-12):658-61. [Medline].

  14. Fenner PJ, Williamson JA, Burnett JW, et al. The "Irukandji syndrome" and acute pulmonary oedema. Med J Aust. Aug 1 1988;149(3):150-6. [Medline].

  15. Freudenthal AR, Joseph PR. Seabather's eruption. N Engl J Med. Aug 19 1993;329(8):542-4. [Medline].

  16. Giordano AR, Vito L, Sardella PJ. Complication of a Portuguese man-of-war envenomation to the foot: a case report. J Foot Ankle Surg. Jul-Aug 2005;44(4):297-300. [Medline].

  17. Flomembaum N, Goldfrank LR, Howland MA, Lewin NA, Hoffman RS, Nelson LS. Goldfrank's Toxicologic Emergencies. 8th ed. 2006.

  18. Haddad L, Lee L. Toxic marine life. In: Clinical Management of Poisoning and Drug Overdose. 3rd ed. WB Saunders Co; 1998:386-399.

  19. Kimball AB, Arambula KZ, Stauffer AR, et al. Efficacy of a jellyfish sting inhibitor in preventing jellyfish stings in normal volunteers. Wilderness Environ Med. Summer 2004;15(2):102-8. [Medline].

  20. Kizer KW. Marine envenomations. J Toxicol Clin Toxicol. 1983-1984;21(4-5):527-55. [Medline].

  21. Little M. Is there a role for the use of pressure immobilization bandages in the treatment of jellyfish envenomation in Australia?. Emerg Med (Fremantle). Jun 2002;14(2):171-4. [Medline].

  22. Lumley J, Williamson JA, Fenner PJ, et al. Fatal envenomation by Chironex fleckeri, the north Australian box jellyfish: the continuing search for lethal mechanisms. Med J Aust. May 16 1988;148(10):527-34. [Medline].

  23. McGoldrick J, Marx JA. Marine envenomations. Part 2: Invertebrates. J Emerg Med. Jan-Feb 1992;10(1):71-7. [Medline].

  24. Mizuno M, Nozaki M, Morine N, et al. A protein toxin from the sea anemone Phyllodiscus semoni targets the kidney and causes a severe renal injury with predominant glomerular endothelial damage. Am J Pathol. Aug 2007;171(2):402-14. [Medline].

  25. Nimorakiotakis B, Winkel KD. Marine envenomations. Part 1--Jellyfish. Aust Fam Physician. Dec 2003;32(12):969-74. [Medline].

  26. Pearn J. The sea, stingers, and surgeons: the surgeon's role in prevention, first aid, and management of marine envenomations. J Pediatr Surg. Jan 1995;30(1):105-10. [Medline].

  27. Perkins RA, Morgan SS. Poisoning, envenomation, and trauma from marine creatures. Am Fam Physician. Feb 15 2004;69(4):885-90. [Medline].

  28. Stein MR, Marraccini JV, Rothschild NE, et al. Fatal Portuguese man-o'-war (Physalia physalis) envenomation. Ann Emerg Med. Mar 1989;18(3):312-5. [Medline].

  29. Tibballs J. Australian venomous jellyfish, envenomation syndromes, toxins and therapy. Toxicon. Dec 1 2006;48(7):830-59. [Medline].

  30. Watters MR, Stommel EW. Marine Neurotoxins: Envenomations and Contact Toxins. Curr Treat Options Neurol. Mar 2004;6(2):115-123. [Medline].

  31. Weisman R. Marine animals. In: Goldfrank LR. Goldfranks's Toxicologic Emergencies. 5th ed. Appleton & Lange; 1994:1327-1332.

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Further Reading

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Keywords

jellyfish envenomation, cnidaria envenomation, jellyfish sting, box jellyfish, aquatic invertebrates, Hydrozoa, Portuguese man-of-war, fire coral, Scyphozoa, true jellyfish, Cubozoa, Anthozoa, sea anemone, coelenterate envenomation,  

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Contributor Information and Disclosures

Author

G Patrick Daubert, MD, Assistant Professor, Assistant Medical Director, Sacramento Division, California Poison Control System; Director of Clinical and Medical Toxicology Education, Department of Emergency Medicine, University of California, Davis Medical Center
G Patrick Daubert, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Medical Toxicology, American Medical Association, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Medical Editor

Dana A Stearns, MD, Assistant Director of Undergraduate Education, Department of Emergency Medicine, Massachusetts General Hospital
Dana A Stearns, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

A Antoine Kazzi, MD, Chair and Medical Director, Department of Emergency Medicine, American University of Beirut, Lebanon
A Antoine Kazzi, MD is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Scott H Plantz, MD, FAAEM, Associate Clinical Professor of Emergency Medicine, Rosalind Franklin University of Medicine and Science, Chicago Medical School; Medical Director, WeCare Med,Inc
Scott H Plantz, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine
Disclosure: Nothing to disclose.

 
 
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