#TOXINology see also: [[Box jellyfish]], [[Marine Envenomation]] > [!important] Key Points > - Antidote:: none > - key_points:: risk for toxic cardiomyopathy, cardiogenic shock, pulm oedema # Overview * Patients with Irukandji syndrome often have minimal symptoms at the time of the sting. * After a latent period of up to 60 minutes the ‘Irukandji syndrome’ may develop, with clinical features of catecholamine excess that include restlessness, anxiety, diaphoresis, vomiting, abdominal, chest and back pain, blood pressure lability and tachycardia. * It is reported that 20% of victims develop raised cardiac markers, 6% develop echocardiographic evidence of myocardial dysfunction and 2% develop clinical cardiac failure. * Although most patients settle within 6 hours, all patients developing cardiac dysfunction have ongoing pain From Carukia barnesi # Clinical features initially not felt and delay in symptoms. usually few demrmal markings (unlike box jellies) - Multiple systemic symptoms develop from 30 to 120 minutes after contact with the jellyfish. - a sense of impending doom, agitation, dysphoria, vomiting, generalised sweating and severe pain in the back - severe envenoming within 4 hours - risk of toxic cardiomyopathy, cardiogenic shock, pulm oedema - **+++ hypertension** > hypotension suggests cardiac failure # Treatment - vinegar to all visible sting sites to inactivate all undischarged nematocysts - IV fentanyl may need large doses eg 200-300mcg. - nausea IV promethazine 25mg (0.5m/kg in children) - HTN refractory to opiates with IV GTN target SBP <160 - +/- clonidine - +/- Iv magnesium # Disposition without features of systemic envenoming at 2 hours do not have irukandji syndrome and do not need medical observation pts with severe pain who need opiates can be d/c'd when clinically well for period of 6 hours Symptoms usually resolve within 12 hours