See also: [[Blue-ringed octopus]], [[Box jellyfish]], [[Irukandji Syndrome]], [[Sea Urchin injury]] [[Water-immersed wound infections]] don't confuse with [[marine ingestions]] #TOXINology | | symptoms | toxin | antivenom | other treatments | | ---- | ---- | ---- | ---- | ---- | | blue-ringed octopus | - rapidly-progressive *descending flaccid paralysis* with resp failure in minutes<br>- hypotension<br>- collapse | Tetrodotoxin - sodium channel blocking neurotoxin | no antivenom | - intubation (paralysis)<br>- pressure bandage | | box jellyfish (chironex fleckeri) | - collapse, cardiogenic failure, APO | ?affects calcium channels | Box Jellyfish antivenom (6 if arrest, 3 hypotensive/arrhythmia, 1 for refractive pain) | - ice packs<br>- vinegar<br>- remove tentacles <br>- CPR | | bluebottle jellyfish | | | | | | irukandji syndrome (carukia barnesi) | - delayed symptoms 60 min<br>- features of catecholamine excess that include restlessness, anxiety, diaphoresis, vomiting, abdominal, chest and back pain, blood pressure lability and tachycardia. <br>- usually settle in 6 hours<br>- 20% get raised trop, 2% get CHF | | | - vinegar to all visible sting sites to inactivate all undischarged nematocysts<br>- IV fentanyl may need large doses eg 200-300mcg. <br>- nausea IV promethazine 25mg (0.5m/kg in children)<br>- HTN refractory to opiates with IV GTN target SBP <160 | | sea snake | - bites small and *painless*<br>- symmetrical descending flaccid *paralysis* (ptosis, diplopia, swallowing, resp failure)<br>- can lead to hypoxic arrest<br>- *rhabdomyolysis*, diffuse myalgia, elevated CK, renal failure | neurotoxins and myotoxins | CLS sea snake antivenom 1ampoule (1000 units) | | | stonefish | - immediate *severe pain* at sting site<br>- no deaths in ausralia<br>- nausea, vomiting, dysponea<br>- no cardiovascular signs<br>- can consider regional block with ropivacane if ++ pain<br>- IV morphine 0.1 mg/kg Q10 min | | stonefish antivenom if severe pain refractory to first aid and analgesia <br>- 1 ampoule (2000 units) for ever 2 spine puncture wounds to max of 3 ampoules | | | stingray | | | | | | cone shell | | | | |