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  • For most marine stings, local wound care, irrigation, tetanus immunization, wound exploration for foreign bodies, and selected antibiotic coverage are standard therapies.
  • Hot water soaks are recommended for stingray, scorpion fish, echinoderm, and catfish stings.
  • Dermatologic irrigation with vinegar, rubbing alcohol, household ammonia, baking soda, or papain will neutralize many coelenterate envenomations, including jellyfish.
  • Antivenoms are available for stonefish, box jellyfish, and sea snake envenomations.

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As more humans venture into aquatic environments for recreational activities, vacations, and an improved quality of life, the opportunity for children to encounter venomous marine life increases. Also, as more aquarists collect exotic marine life for display in the home, the incidence of bites and stings will rise regardless of the geographic locale.1 Hazardous marine life can be classified into four major groups:

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  • Venomous bites and stings, such as those inflicted by scorpion fish and the Portuguese man-o'-war.
  • Shock injuries, as from electric eels.
  • Traumatogenic bites (such as from sharks and barracudas).
  • Toxic ingestions or fish poisoning.2

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This chapter will discuss venomous bites and stings.

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Toddlers are most likely to be envenomed in shallow waters and are typically unable to give a detailed or reliable history. Young children may step on poisonous marine animals or handle them resulting in extremity stings. Adolescents are more adventurous and frequent deeper waters as surfers,3 ocean swimmers, snorkelers, and scuba divers.4 This age group is also more susceptible to intoxication with ethanol or recreational drugs.1

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Coelenterates (phylum Cnidaria) include jellyfish, sea anemones, and corals. Jellyfish stings are the most common marine envenomations, with an estimated 500 000 annual stings occurring in the Chesapeake Bay and 250 000 in Florida. A commonly encountered jellyfish is the sea nettle (Chrysaora quinquecirrha), which is widely distributed in temperate and tropical waters. One of the more feared jellyfishes is the Portuguese man-o'-war (Physalia physalis). This jellyfish is most commonly found in the Gulf of Mexico and off the Florida coasts between July and September. Its tentacles can reach up to 30 meters in length (Fig. 136–1). The deadliest and most venomous of coelenterates is the box jellyfish or sea wasp of Australia (Fig. 136–2).57

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Pathophysiology

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Coelenterates envenomate with organelles called nematocysts, which contain venom-bearing threads that reside within specialized epithelial cells on the tentacles. Each nematocyst is a capsule with a folded eversible tubule, carrying a variety of toxins with neurologic, cytolytic, and enzymatic effects. Upon contact or when encountering a change in osmolality, these threads are everted from the nematocysts in order to be thrust into the prey (Fig. 136–3). ...

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