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Bites and stings – marine
STEPHEN H. THOMAS AND CIARAN J. BROWNE
n Agents
n Antivenom
n Opioids
n Magnesium
n Local anesthetics
n Acetic acid (vinegar)
n Papain (proteolytic meat tenderizer)
n Slurry of bicarbonate (baking soda)
n Evidence
Marine envenomation can result from discharging nematocysts (e.g. jellyfish,
fire coral), puncturing spines (e.g. sea urchins, stingrays), or actual bites
(e.g. blue octopus, sea snakes). The preponderance of the evidence, and
thus most of this chapter’s focus,addressesjellyfish(Cnidaria or Coelenterates)
envenomation.
In keeping with this text’s aim, this discussion emphasizes pharmacotherapy,
but one physical modality deserves mention. For most marine envenomations,
hot water immersion (40–45 °C via immersion or shower, for up to
90 min) can inactivate venom and achieve better pain relief than alternative
approaches such as acetic acid, papain,oropioids. 1–5 One recent US series of
over 100 stingray envenomations found that hot water immersion alone was
sufficient for pain therapy in nearly 90% of patients. 6
Whether considering physical interventions (e.g. hot water immersion),
topical therapies (e.g. acetic acid dousing), or IV drug therapy (e.g. with
antivenom), treatments for different marine envenomations – even those
from different members of the same genus – can vary significantly. Be aware
of local species, and be wary of overextrapolating clinical trials data. Although
it may be impossible to identify the organism responsible for a given
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