Irukandji syndrome: Difference between revisions
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'''Background''' | =='''Background'''== | ||
*Caused by certain jellyfish from the Cubozoa class (box jellyfish) species | *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> | *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> | * 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> | ||
'''Clinical Features''' | =='''Clinical Features'''== | ||
*Rare but potentially fatal complications can manifest in diverse ways: | *Rare but potentially fatal complications can manifest in diverse ways: | ||
**Myalgias | **Myalgias | ||
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**Death | **Death | ||
'''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> | ==Evaluation== | ||
*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/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> | |||
*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) d/t potential for hypotension in the later stages of toxicity | *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 | ||
Revision as of 22:27, 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
Evaluation
- 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/vinegar & Hot water immersion (111-114F)[3]
- 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
- ↑ 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/
- ↑ 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/.