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Stingray Envenomation Clinical Presentation

  • Author: John L Meade, MD; Chief Editor: Scott H Plantz, MD, FAAEM  more...
 
Updated: Feb 05, 2016
 

History

Stingrays commonly are found lying half-buried in the sand or mud of coastal temperate areas.

Injuries tend to occur when an unsuspecting person steps on the fish, causing the animal to reflexively strike the person with its defensive mechanism.

The stingray's tail has one or more barbed stingers and 2 ventrolateral venom-containing grooves that are encased in an integumentary sheath. The tail is thrust into the victim, usually in the foot or lower leg, producing a deep jagged laceration from the serrated spine(s). A stingray spine is shown below.

Spine removed from stingray injury. Image courtesy Spine removed from stingray injury. Image courtesy of Scott Plantz, MD.

The stinger apparatus then injects a protein-based toxin into the wound, causing immediate intense (even excruciating) pain in the victim. Injury may occur without envenomation because many stingrays lose or tear the integumentary sheath covering the venom glands.

This subject has taken on new worldwide interest due to the unfortunate death of the celebrity wildlife naturalist Steve Irwin (also known as "The Crocodile Hunter") on September 4, 2006. Irwin was filming a documentary on stingrays in Queensland, Australia, when he reportedly suffered a puncture wound of the heart from a stingray barb. He died on the scene. This is a very rare injury since most stingray puncture wounds occur on the extremities and are not very deep.

Next

Physical

The wound may bleed freely and the patient may have systemic symptoms, including the following:

  • Syncope
  • Nausea
  • Vomiting
  • Diarrhea
  • Diaphoresis
  • Muscle cramps
  • Fasciculations
  • Abdominal pain
  • Seizures
  • Hypotension

  Pseudoaneurysm of the superficial femoral artery has been reported following stingray envenomation.[2]

Stringray wounds are shown in the images below.

Typical stingray puncture wound on a foot, approxi Typical stingray puncture wound on a foot, approximately 60 minutes after injury. Photo by John L. Meade, MD.
Stingray barb in forearm. Photo by John L. Meade, Stingray barb in forearm. Photo by John L. Meade, MD.
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Contributor Information and Disclosures
Author

John L Meade, MD CEO, Statdoc Consulting, Inc

John L Meade, MD is a member of the following medical societies: American College of Emergency Physicians, Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Specialty Editor Board

John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals

John T VanDeVoort, PharmD is a member of the following medical societies: American Society of Health-System Pharmacists

Disclosure: Nothing to disclose.

Richard H Sinert, DO Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Vice-Chair in Charge of Research, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Scott H Plantz, MD, FAAEM Associate Clinical Professor of Emergency Medicine, Department of Emergency Medicine, University of Louisville School of Medicine

Scott H Plantz, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Richard S Krause, MD Senior Clinical Faculty/Clinical Assistant Professor, Department of Emergency Medicine, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

Richard S Krause, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. de Haro L, Pommier P. Envenomation: a real risk of keeping exotic house pets. Vet Hum Toxicol. 2003 Aug. 45(4):214-6. [Medline].

  2. Campbell J, Grenon M, You CK. Pseudoaneurysm of the superficial femoral artery resulting from stingray envenomation. Ann Vasc Surg. 2003 Mar. 17(2):217-20. [Medline].

  3. O'Malley GF, O'Malley RN, Pham O, Randolph F. Retained Stingray Barb and the Importance of Imaging. Wilderness Environ Med. 2015 Sep. 26 (3):375-9. [Medline].

  4. Fenner PJ, Williamson JA, Skinner RA. Fatal and non-fatal stingray envenomation. Med J Aust. 1989 Dec 4-18. 151(11-12):621-5. [Medline].

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

  6. Clark RF, Girard RH, Rao D, Ly BT, Davis DP. Stingray envenomation: a retrospective review of clinical presentation and treatment in 119 cases. J Emerg Med. 2007 Jul. 33(1):33-7. [Medline].

  7. Ellenhorn MJ. Envenomations: bites and stings. Ellenhorn's Medical Toxicology. Lippincott Williams & Wilkins; 1997. 1737-98.

  8. Guenin DG, Auerbach PS. Trauma and envenomations from marine fauna. Tintinalli JE, et al, eds. Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill; 1996. 868-73.

  9. Otten EJ. Venomous animal injuries. Rosen P, et al, eds. Emergency Medicine: Concepts and Clinical Practice. Mosby-Year Book; 1998. 924-40.

 
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Typical stingray puncture wound on a foot, approximately 60 minutes after injury. Photo by John L. Meade, MD.
Stingray barb in forearm. Photo by John L. Meade, MD.
Stingray barb broken off in ring finger. Photo by John L. Meade, MD.
Spine removed from stingray injury. Image courtesy of Scott Plantz, MD.
Stingray.
Stingray.
 
 
 
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