Cone shell envenomation

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Background

A dangerous cone to handle, Conus textile.
  • Also known as cone snails
  • Conus genus includes 800 species[1]
  • Human fatality rates 15-75%[2]
  • Neurotoxin, paralytic venoms with a variety of neuromuscular effects through glutamate, adrenergic, serotonin, and cholinergic pathways

Clinical Features

  • Sharp prick to extreme pain
  • Envenomation site: numbness, swelling, ischemia, cyanosis
  • Systemic: weakness, sweating, visual changes, muscle paralysis, respiratory failure, cardiovascular collapse, coma
  • Death can occur in 1-5 hours

Differential Diagnosis[3]

  • Anaphylaxis
  • Cnidaria envenomation
  • Sea snake envenomation
  • Shellfish envenomation

Evaluation

Workup

  • Due to systemic symptoms CMP, Chest X-ray, EKG are reasonable[4]

Diagnosis

  • Clinical history

Management

  • No antivenom available
  • ABC's
  • Prepare for mechanical ventilation with supportive care
  • Most patients will develop a chronic wound at the envenomnation site with ulceration that often requires persistent care.
  • Hot water (40C-50C) may provide pain relief based on anecdotal reports

Disposition

  • ICU if intubated
  • No clear information on length of observation

See Also

External Links

References

  1. Kohn AJ. Conus Envenomation of Humans: In Fact and Fiction. Toxins (Basel). 2018;11(1):10. Published 2018 Dec 27. doi:10.3390/toxins11010010
  2. Kapil S, Hendriksen S, Cooper JS. Cone Snail Toxicity. [Updated 2020 Sep 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470586/
  3. Kapil S, Hendriksen S, Cooper JS. Cone Snail Toxicity. [Updated 2020 Sep 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470586/
  4. Kapil S, Hendriksen S, Cooper JS. Cone Snail Toxicity. [Updated 2020 Sep 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK470586/