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Octopus Envenomation: Treatment & Medication

Author: Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Contributor Information and Disclosures

Updated: Aug 14, 2008

Treatment

Prehospital Care

  • Cardiopulmonary support, including endotracheal intubation and cardiopulmonary resuscitation (CPR), as clinically indicated.
  • What constitutes proper wound care for octopus envenomation is controversial. Options include the following:
    • Immediately irrigate and care for the wound, as one would for any puncture wound.
    • Perform local suction without incision or local sequestration of the venom by applying a constricting band proximal to the injury.
    • Perform pressure immobilization technique, which is done by compressing a cloth pad with a bandage directly over the wound and surrounding tissues at 9.3 kPa (70 mm Hg) or greater of pressure.

Emergency Department Care

Treatment of octopus envenomation is supportive.

  • Provide endotracheal intubation and ventilatory support until the venom has worn off, usually within 4-10 hours.
  • Confirm that the patient's tetanus status is current.
  • No antivenin is available.
  • Neostigmine and edrophonium have shown benefit in restoring muscular strength in some cases of tetrodotoxin intoxication (eg, puffer fish), but have not undergone clinical trials in blue-ringed octopus envenomations.
  • 4-Aminopyridine (Neurelan - US, Pymadine), a drug utilized as an antagonist to nondepolarizing neuromuscular blocking agents (available in the US as an orphan drug for multiple sclerosis), has been shown to reverse tetrodotoxin toxicity in animal experiments.

Consultations

  • A general surgery consult may be indicated for wide excision of the wound. However, this has not proven to improve outcome.
  • A medical toxicologist (certified by the American Board of Medical Toxicology or the American Board of Emergency Medicine), or a poison control center certified by the American Association of Poison Control Centers, should be contacted regarding this uncommon intoxication.

Medication

The goal of pharmacotherapy is to reduce morbidity and prevent complications. Administration of nondepolarizing neuromuscular blocking antagonists may be beneficial. 4-Aminopyridine (Neurelan) is utilized as an antagonist to nondepolarizing neuromuscular blocking agents (available in the US as an orphan drug for multiple sclerosis), has been shown to reverse tetrodotoxin toxicity in animal experiments. The dosing regimen for use in octopus envenomation is not yet established.

More on Octopus Envenomation

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

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

  2. Chang FCT, Spriggs DL, Benton BJ, et al. 4-Aminopyridine reverses saxitoxin (STX)- and tetrodotoxin (TTX)- induced cardiorespiratory depression in chronically instrumented guinea pigs. Fundam Appl Toxicol. Jul 1997;38(1):75-88. [Medline].

  3. Flachsenberger WA. Respiratory failure and lethal hypotension due to blue-ringed octopus and tetrodotoxin envenomation observed and counteracted in animal models. J Toxicol Clin Toxicol. 1986-87;24(6):485-502. [Medline].

  4. Kizer KW. Marine envenomations. J Toxicol Clin Toxicol. 1983-84;21(4-5):527-55. [Medline].

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

  6. Nimorakiotakis B, Winkel KD. Marine envenomations. Part 2--Other marine envenomations. Aust Fam Physician. Dec 2003;32(12):975-9. [Medline].

  7. Oda K, Araki K, Totoki T, et al. Nerve conduction study of human tetrodotoxication. Neurology. May 1989;39(5):743-5. [Medline].

  8. Walker DG. Survival after severe envenomation by the blue-ringed octopus (Hapalochlaena maculosa). Med J Aust. Dec 10-24 1983;2(12):663-5. [Medline].

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

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Further Reading

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Keywords

octopus envenomation, octopus poisoning, octopus bite, blue-ringed octopus envenomation, Hapalochlaena lunulata envenomation, Hapalochlaena maculosa envenomation, Cephalopoda, Mollusca

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Contributor Information and Disclosures

Author

Jon Mark Hirshon, MD, MPH, Associate Professor, Department of Emergency Medicine, University of Maryland School of Medicine
Jon Mark Hirshon, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Public Health 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

John T VanDeVoort, PharmD, ABAT, Director of Pharmacy, Sacred Heart Hospital
John T VanDeVoort, PharmD, ABAT is a member of the following medical societies: American Academy of Clinical Toxicology and American Society of Health-System Pharmacists
Disclosure: Nothing to disclose.

Managing Editor

James Steven Walker, DO, MS, Clinical Professor of Surgery, Department of Surgery, University of Oklahoma Health Sciences Center
James Steven Walker, DO, MS is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Osteopathic Emergency Physicians, and American Osteopathic Association
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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