Difference between revisions of "Irukandji syndrome"

(Management)
(Evaluation)
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**Bites ([[alligator and crocodile attacks|alligator/crocodile]], [[octopus bite|octopus]], [[shark bite|shark]])
 
**Bites ([[alligator and crocodile attacks|alligator/crocodile]], [[octopus bite|octopus]], [[shark bite|shark]])
  
==Evaluation==
+
==Evaluation== <ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>
 
*Electrocardiogram
 
*Electrocardiogram
 
*Cardiac enzymes
 
*Cardiac enzymes

Revision as of 22:35, 22 July 2021

Background

  • Caused by certain jellyfish from the Cubozoa class (box jellyfish) species
  • Usually develops within 2 hours of envenomation & can last up to 2 days [1]
  • The sympathomimetic-like manifestations are due to the venom, which is proteinaceous and contains a neural sodium channel activator. **Acts on the same sodium channels that are sensitive to tetrodotoxin, causing the release of catecholamines, particularly norepinephrine and epinephrine, and also direct vasoconstrictor effects.[2]

Clinical Features

  • Rare but potentially fatal complications can manifest in diverse ways:
    • Myalgias
    • Back pain
    • Chest pain
    • Abdominal pain
    • Nausea and vomiting
    • Diaphoresis
    • Hypertensive crisis
    • Cardiogenic pulmonary edema
    • Intracranial hemorrhage
    • Death

Differential Diagnosis

==Evaluation== [3]

  • Electrocardiogram
  • Cardiac enzymes
  • Chemistry
  • Blood count
  • Liver enzymes
  • Lipase
  • Chest X-ray
  • Bedside echocardiogram if acute heart failure is suspected
  • CT imaging of the brain in cases of headache or acute encephalopathy

Management

  • Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)[4]
  • IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids
  • Hypertension should be treated with short-acting titratable medications (eg., phentolamine, esmolol, nicardipine, nitroprusside) d/t potential for hypotension in the later stages of toxicity

References

  1. Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.
  2. Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/
  3. Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/
  4. Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.