Difference between revisions of "Irukandji syndrome"
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− | + | ==Background== | |
− | * | + | [[File:Avispa marina cropped.png|thumb|Box jellyfish]] |
− | * | + | [[File:Nematocyst discharge.png|thumb|Nematocyst stages of discharge]] |
− | * | + | *Caused by certain jellyfish from the Cubozoa class ([[box jellyfish]]) species |
− | + | *Usually develops within 2 hours of envenomation & can last up to 2 days <ref> 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/.</ref> | |
− | + | * 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.<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> | |
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− | + | ==Clinical Features== | |
− | * | + | *Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge. |
+ | **Beware of [[hypertensive emergency]]: Look for signs of end organ damage (ie ACS, CHF, intracranial hemorrhage, renal injury) | ||
+ | |||
+ | ==Differential Diagnosis== | ||
+ | {{Marine envenomation DDX}} | ||
+ | |||
+ | ==Evaluation== | ||
+ | *EKG | ||
+ | *Troponin & ProBNP | ||
+ | *CBC | ||
+ | *CMP | ||
+ | *Lipase | ||
+ | *Chest X-ray | ||
+ | *CT imaging of the brain in cases of headache or acute encephalopathy<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> | ||
+ | |||
+ | ==Management== | ||
+ | *Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)<ref> 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/.</ref> | ||
+ | *Fentanyl IV or other opiate for pain. | ||
*IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids | *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) | + | *Hypertension should be treated with short-acting titratable medications (eg., nitroglycerin, phentolamine, esmolol, nicardipine, nitroprusside) due to potential for hypotension in the later stages of toxicity |
+ | |||
+ | ==Disposition== | ||
+ | |||
+ | ==See Also== | ||
+ | *[[Box jellyfish]] | ||
+ | |||
+ | ==External Links== | ||
+ | |||
+ | ==References== | ||
+ | <references/> | ||
+ | |||
+ | [[Category:Environmental]] | ||
+ | [[Category:Toxicology]] |
Latest revision as of 02:42, 31 July 2021
Contents
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 complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.
- Beware of hypertensive emergency: Look for signs of end organ damage (ie ACS, CHF, intracranial hemorrhage, renal injury)
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
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
Evaluation
- EKG
- Troponin & ProBNP
- CBC
- CMP
- Lipase
- Chest X-ray
- CT imaging of the brain in cases of headache or acute encephalopathy[3]
Management
- Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)[4]
- Fentanyl IV or other opiate for pain.
- 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., nitroglycerin, phentolamine, esmolol, nicardipine, nitroprusside) due to potential for hypotension in the later stages of toxicity
Disposition
See Also
External Links
References
- ↑ 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/.
- ↑ 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/
- ↑ 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/
- ↑ 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/.