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Chapter: Modern Medical Toxicology: Organic Poisons (Toxins): Venomous Bites and Stings

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General Treatment Measures for Cnidarian Stings

Anaphylaxis to jellyfish sting must be treated by main-taining airway and cardiovascular status.

General Treatment Measures for Cnidarian Stings

·       Anaphylaxis to jellyfish sting must be treated by main-taining airway and cardiovascular status. Adrenaline is administered in the usual way. Verapamil may be useful for arrhythmias. Antihistamines with or without inhaled beta agonists, and corticosteroids may be required. Topical corticosteroids and oral antihistamines are indicated in delayed hypersensitivity reactions.

·              Remove any adhering tentacles carefully without too much tactile pressure which may cause additional nematocyst discharge. Do not rub the affected area.

·              Inactivate unexploded nematocysts by topical application of any of the following solutions for at least half an hour:

o       Vinegar (3 to 5% acetic acid). Altering pH below 6 inactivates the venom.

o     A slurry (50% w/u) of sodium bicarbonate or baking soda. Altering pH above 8 dissolves tentacles.

o     Aluminium subacetate 10 to 20% (Burow’s solution). The aluminium ion denatures protein constituents of venom. Adding 5% detergent enhances efficacy.

o     Meat tenderiser (papain). It causes denaturation of protein constituents, but is not as effective as aluminium subacetate.

·              Apply dry baking soda, flour, sand, or shaving soap to the affected area.

·              Scrape off remaining nematocysts from the wound with a knife.

·              Wash the area with seawater: Bathe the affected part liberally with seawater. Do not use fresh or hot water, or alcohol. Fresh water/alcohol may discharge nematocysts and therefore should be avoided.

·              Apply a steroid cream or lotion (e.g. triamcinolone 0.1%). If the lesion ulcerates, clean daily with Burow’s solution and cover with dry dressings.

·       Administer tetanus prophylaxis.

·       For pain: Apply ice-packs for initial pain relief combined with IV or IM analgesics, if necessary (1 mg/kg of pethi-dine up to 50 mg, or morphine, 0.1 mg/kg up to 5 mg; can be repeated).

·       Painful muscle spasms may be relieved by calcium gluco-nate 10% IV.

·       For hypotension: Infuse 10 to 20 ml/kg of isotonic fluid and place in Trendelenburg position. If hypotension persists, administer dopamine or noradrenaline. Institute central venous pressure monitoring to guide further fluid therapy.

·              For box jellyfish envenomation, specific antivenom is available (Commonwealth Serum Laboratories, Melbourne, Australia). It should be given in life-threatening stings, or severe stings where the pain is not controlled by other methods. The antivenom should preferably be given within 4 to 6 hours.


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