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Stingray Envenomation

Author: John L Meade, MD, CEO, Statdoc Consulting, Inc; Medical Director and Member, Orange Beach Police Department SRT (SWAT); Medical Director, Multiple EMS Agencies
Contributor Information and Disclosures

Updated: Nov 19, 2008

Introduction

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 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) contains poisonous species known as freshwater stingrays. These freshwater stingrays live in lakes and rivers of South America.

Also see Cutaneous Manifestations Following Exposures to Marine Life.

Clinical

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).
  • 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.

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

More on Stingray Envenomation

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

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

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

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

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

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

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

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

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Further Reading

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Keywords

stingray envenomation, stingray wound, stingray barb, marine, envenomations, stingrays, sting rays, elasmobranch, Dasyatidae, Potamotrygonidae, stingray, sting ray, fish injuries, beach injuries, stingray spine

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Contributor Information and Disclosures

Author

John L Meade, MD, CEO, Statdoc Consulting, Inc; Medical Director and Member, Orange Beach Police Department SRT (SWAT); Medical Director, Multiple EMS Agencies
John L Meade, MD, CEO is a member of the following medical societies: American College of Emergency Physicians and Medical Association of the State of Alabama
Disclosure: Nothing to disclose.

Medical Editor

Richard S Krause, MD, Clinical Assistant Professor, Residency Program Director, Department of Emergency Medicine, State University of New York at Buffalo School of Medicine
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, and Society for Academic Emergency Medicine
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

Richard H Sinert, DO, Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center
Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic 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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