Stingray Envenomation

Updated: May 04, 2017
  • Author: John L Meade, MD; Chief Editor: Joe Alcock, MD, MS  more...
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Overview

Background

Stingrays (ie, elasmobranchs) are bottom-dwelling cartilaginous fish that have a flattened body, one or more stout spines on the tail, gill slits on the lower surface of the head, teeth modified into 2 large crushing plates, and no dorsal fin. They are not aggressive toward humans; however, injuries from these animals are very common. Stingrays are shown in the images below.

Stingray. Stingray.
Stingray. Stingray.

Stingrays from the northern hemisphere make up the family Dasyatidae. These fish are marine creatures (ie, live in salt water) but also have been found in brackish waters and bays. Another ray family (Potamotrygonidae) [1] contains poisonous species known as freshwater stingrays. These freshwater stingrays live in lakes and rivers of South America.

See Deadly Sea Envenomations, a Critical Images slideshow, to help make an accurate diagnosis.

Also see Cutaneous Manifestations Following Exposures to Marine Life.

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Prognosis

Stingray injuries (eg, puncture wounds, lacerations, envenomations) tend to have good outcomes. If patients do not develop infection or other complications, they can expect to have minimal pain in 24-48 hours and healing within 1-2 weeks.

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Patient Education

Following is an example of discharge instructions that could be given to patients after treatment of stingray injuries.

Because so many areas of water are nearby, many types of injuries associated with being in or near the water are encountered. These injuries may occur while fishing, walking on the beach, playing in the surf, diving, or working with a home aquarium.

Stingrays often cause lacerations and puncture wounds when the tail whips up and thrusts its barbed spine into the victim, depositing venom (poison). The pain is severe immediately and worsens over the next hour. The pain may last 48 hours. Although rare, deaths have occurred from stingray injuries.

As soon as possible, the wound should be soaked for 30-90 minutes in very hot water (as hot as can be endured without causing burns). The heat inactivates the poison and dramatically relieves the pain. The physician may prescribe pain medication. Also, because the risk of infection is very high, antibiotics are given to prevent infection.

Despite the best of care, any wound can develop infection or other complications. If any of the following occur, it is recommended that patients call their own doctor, the referral physician, or clinic (If a physician cannot be contacted, return to the ED is advised.):

  • Wound drainage increases, shows pus, or develops a foul odor
  • Wound bleeds heavily
  • Wound becomes more sore or swollen
  • Wound develops increasing redness, or red streaks develop
  • A fever develops
  • Wound does not appear to be healing properly
  • Any other new or worsening symptoms that are of concern

For patient education resources, see the Bites and Stings Center, as well as Stingray Injury.

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