Stingray injury

Background

• Stinger punctures skin to introduce heat-labile venom
• Generally causes local symptoms without systemic effects
• Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.

Common stingray (Dasyatis pastinaca)

A stingray's stinger (ruler in cm)

Clinical Features

• Symptoms can vary by species
• Associated with puncture or jagged laceration
• Local pain, irritation, erythema
• Systemic symptoms can include vomiting, muscle cramps, hypotension, paralysis, cardiac arrest

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
• Consider x-ray to evaluate for retained foreign body (stinger)

Management

• Immediately immerse wound in hot water (45°C for 30-90min)
• Supportive care
• Remove spines and stinger, if visible
• XR for evaluation of foreign bodies
• Tetanus prophylaxis
• Prophylactic antibiotics are controversial - if used, give Ciprofloxacin to cover Vibrio vulnificus

Disposition

• Discharge

See Also

• Marine toxins and envenomations