Laboratory Studies
No assay for conotoxins is currently commercially available. No specific laboratory abnormality is described for cone shell envenomation.
In acutely ill individuals, obtain blood for a complete blood cell count, electrolytes, and coagulation studies if indicated. A serum lactate can assist in guiding resuscitative efforts.
Obtain arterial blood gas measurement to assess for adequacy of gas exchange and oxygenation.
Imaging Studies
After the airway is secure, a chest radiograph should be obtained to assess for endotracheal tube placement and any pulmonary abnormalities such as pulmonary edema or ARDS. Imaging studies at the site of envenomation such as plain radiographs or soft-tissue ultrasound may aid evaluations for retained stingray barbs, foreign bodies, or other possible causes of local symptoms. Radular teeth are may be too small to be clearly visualized on plain radiography.
Other Tests
Serial tests for sufficiency of respiratory effort such as negative inspiratory force (NIF) and forced vital capacity (FVC) may be useful in cases in which overt respiratory insufficiency is absent. These tests have not been validated in cone snail envenomation but may provide early warning of respiratory insufficiency.
Procedures
Emergent endotracheal intubation may be necessary to protect the airway and to begin mechanical ventilation in patients with respiratory insufficiency.
-
Cone snail ingesting a small fish. Cone snails incapacitate their prey by injecting a cocktail of neurotoxins, which can be dangerous to humans. Courtesy of Wikimedia Commons and David Burdick.
