Irukandji syndrome
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
- Marine toxins and envenomations
- Toxins (ciguatera, neurotoxic shellfish poisoning, paralytic shellfish poisoning, scombroid, tetrodotoxin
- Stingers (stingray injury)
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish, cone shells, lionfish, sea urchins)
- Nematocysts (coral reef, fire coral, box jellyfish, sea wasp, portuguese man-of-war, sea anemones)
- Phylum porifera (sponges)
- Bites (alligator/crocodile, octopus, shark)
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]
- 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/
- ↑ 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/.