Stingray injury

Revision as of 01:10, 1 September 2021 by Jonrako (talk | contribs) (→‎Management)

Background [1]

Common stingray (Dasyatis pastinaca)
A stingray's stinger (ruler in cm)
  • Stinger contains a retroserrate barb and venom glands located on the tail.
  • There are two phases to injury.
    • Phase one is d/t the traumatic injury from the barb, which can inflict injury to vital organs (e.g. Steve Irwin)
    • Phase two is d/t heat-labile venom release, which causes vasospasm with possible limb ischemia, cardiotoxicity, seizure, and/or death.
  • Generally causes local symptoms without systemic effects
  • Often occurs when swimmers accidentally step on stingray in shallow water. Can be avoided by shuffling feet along bottom.

Clinical Features

Treatment of stingray injury with hot water.

Differential Diagnosis

Marine toxins, envenomations, and bites


  • Clinical diagnosis
  • Consider x-ray to evaluate for retained foreign body (stinger)


  • Immediately immerse wound in hot water (45°C for 30-90min) [2]
    • Hot water is thought to denature the thermolabile venom
  • Supportive care
  • Remove spines and stinger, if visible
  • XR for evaluation of foreign bodies
  • Tetanus prophylaxis
  • Prophylactic antibiotics are controversial - if used, give doxycycline or ciprofloxacin to cover Vibrio vulnificus
  • Infusion of prostaglandin E1 has resulted in successful salvage of an ischemic leg, but insufficient datat exists to recommend this as routine therapy.
  • There is no antivenom available.


  • Discharge

See Also

External Links


  1. Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 8 of 9. ACEP Now.
  2. Atkinson PRT. Is hot water immersion an effective treatment for marine envenomation? Emergency Medicine Journal. 2006;23(7):503–508. doi:10.1136/emj.2005.028456.