Lionfish envenomation

Background

• From the Scorpaenidae familyof camouflaged bottom-dwelling fish
• Fins have spine connected to venom glands which inject venom when agitated

Clinical Features

• Intense, sharp pain
• Local erythema, ecchymosis, swelling
• Australian stonefish can cause systemic toxicity:
  • hypotension, tachycardia, arrhythmia, syncope, vomiting, and pulmonary edema
• Peak: 60-90 minutes
• Duration: 1-2 days

Differential Diagnosis

Marine toxins, envenomations, and bites

• Toxins
  • Ciguatera
  • Scombroid
  • Tetrodotoxin (e.g. pufferfish)
  • Shellfish poisoning
    • Amnesic shellfish poisoning
    • Diarrheal shellfish poisoning
    • Neurotoxic shellfish poisoning
    • Paralytic shellfish poisoning
• Stingers
  • Stingray injury
• Venomous fish
  • Cone shell
  • Lionfish
  • Sea urchins
  • Crown-of-Thorns Starfish
  • Stonefish
  • Other: Catfish, zebrafish, scorpion fish
• Nematocysts
  • Coral reef
  • Fire coral
  • Jellyfish (Cnidaria)
    • Box jellyfish
      • Irukandji syndrome
    • Sea wasp
  • Portuguese man-of-war
  • Sea anemones
  • Seabather's eruption
• Phylum porifera (sponges)
• Bites
  • Alligator and crocodile attacks
  • Octopus bite
  • Shark bite
• Infections
  • Vibrio species in saltwater
  • Aeromonas species in freshwater

Evaluation

• Clinical diagnosis: no specific testing available

Management

• Clean wound, update tetanus, remove retained tissue
• Immerse extremity in hot water (45 C) for 30-60 minutes
• Stonefish envenomations with severe toxicity can be treated with antivenin obtained through poison control

References

• Olson, K. Poisoning and Drug Overdose Clinical Manual. 2004