Difference between revisions of "Irukandji syndrome"
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'''Background'''<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>
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==Background==
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*Usually develops within 2 hours of envenomation & can last up to 2 days
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[[File:Avispa marina cropped.png|thumb|Box jellyfish]]
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*Rare but potentially fatal complications can manifest in diverse ways:
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[[File:Nematocyst discharge.png|thumb|Nematocyst stages of discharge]]
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**Myalgias
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*Caused by certain jellyfish from the Cubozoa class ([[box jellyfish]]) species
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**Back pain
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*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>
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**Chest pain
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* The sympathomimetic-like manifestations are due to the venom, which is proteinaceous and contains a neural sodium channel activator.
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**Abdominal pain
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**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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**Nausea and vomiting
 
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**Diaphoresis
 
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**Hypertensive crisis
 
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**Cardiogenic pulmonary edema
 
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**Intracranial hemorrhage
 
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**Death
 
  
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'''Management''' <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>
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==Clinical Features==
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*Manage pain with 4-5% acetic acid/vinegar & Hot water immersion (111-114F)
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*Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.
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**Beware of [[hypertensive emergency]]: Look for signs of end organ damage (ie ACS, CHF, intracranial hemorrhage, renal injury)
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==Differential Diagnosis==
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{{Marine envenomation DDX}}
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==Evaluation==   
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*EKG
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*Troponin & ProBNP
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*CBC
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*CMP
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*Lipase
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*Chest X-ray
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*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>   
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==Management==
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*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>
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*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
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*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
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*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
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==Disposition==
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==See Also==
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*[[Box jellyfish]]
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==External Links==
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==References==
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<references/>
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[[Category:Environmental]]
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[[Category:Toxicology]]

Latest revision as of 02:42, 31 July 2021

Background

Box jellyfish
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 [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

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

  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/.
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