Nematocysts: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
*Isolated stinging | *Isolated stinging, pain | ||
*Severe | *Severe | ||
**Respiratory paralysis | **Limb [[weakness|paralysis]] | ||
**Cardiovascular collapse | **[[Respiratory arrest|Respiratory paralysis]] | ||
**[[Shock|Cardiovascular collapse]] | |||
**Death | **Death | ||
| Line 24: | Line 24: | ||
*[[Hypertension]] | *[[Hypertension]] | ||
*[[Tachycardia]] | *[[Tachycardia]] | ||
*Myocardial injury | *[[Myocardial ischemia|Myocardial injury]] | ||
*[[Pulmonary edema]] | *[[Pulmonary edema]] | ||
| Line 36: | Line 36: | ||
*Remove tentacles and nematocysts | *Remove tentacles and nematocysts | ||
*Hot salt water immersion (inactivates heat labile toxins) | *Hot salt water immersion (inactivates heat labile toxins) | ||
*Consider topical lidocaine | *Consider topical [[lidocaine]] | ||
*Consider oral or parenteral analgesia for severe pain | *Consider oral or parenteral analgesia for severe pain | ||
*Acetic Acid may inhibit or trigger nematocyst discharge and thereby increase or decrease pain depending on species (can use fruit juice or other flavored sodas if vinegar not available) | *Acetic Acid may inhibit or trigger nematocyst discharge and thereby increase or decrease pain depending on species (can use fruit juice or other flavored sodas if vinegar not available) | ||
*'''Symptomatic treatment for Irukandji syndrome''' | *'''Symptomatic treatment for Irukandji syndrome''' | ||
*'''Antivenom is available for severe box | *'''Antivenom is available for severe [[box jellyfish]] sting''' | ||
===Avoid=== | ===Avoid=== | ||
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==See Also== | ==See Also== | ||
*[[Marine toxins and envenomations]] | *[[Marine toxins and envenomations]] | ||
*[[Sea wasp]] | |||
==References== | ==References== | ||
Revision as of 15:40, 8 September 2019
Background
- Jellyfish; box jellyfish is most deadly
- Most toxic: Australia and other Indo-Pacific waters
Mechanism
- Physical contact or osmotic gradient causes discharge of nematocysts
- A spring loaded venom delivery system
- Once opened, a nematocyst releases all of its contained venom
Clinical Features
- Isolated stinging, pain
- Severe
Irukandji syndrome
- Myalgias, back, chest,
- Abdominal pain
- Nausea and vomiting
- Diaphoresis
- Hypertension
- Tachycardia
- Myocardial injury
- Pulmonary edema
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
- Generally a clinical diagnosis
Management
- Remove tentacles and nematocysts
- Hot salt water immersion (inactivates heat labile toxins)
- Consider topical lidocaine
- Consider oral or parenteral analgesia for severe pain
- Acetic Acid may inhibit or trigger nematocyst discharge and thereby increase or decrease pain depending on species (can use fruit juice or other flavored sodas if vinegar not available)
- Symptomatic treatment for Irukandji syndrome
- Antivenom is available for severe box jellyfish sting
Avoid
- Urine, ethanol, ammonia
- Fresh or tap water (causes nematocyst discharge via the osmotic gradient)
Disposition
See Also
References
- Ward NT, Darracq MA, Tomaszewski C, et al. Evidence based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2012;60(4):339-414.
- Cegolon L, Heymann WC, Lange JH, et al. Jellyfish stings and their management: a review. Mar Drugs. 2013;11(2): 523-50