Lionfish envenomation

Background

From the Scorpaenidae family of camouflaged bottom-dwelling fish
Fins have spine connected to venom glands which inject venom when agitated

Clinical Features

Local erythema, ecchymosis, swelling
Intense, sharp pain
Australian stonefish can cause systemic toxicity:
- Hypotension, tachycardia, arrhythmia, syncope, vomiting, and pulmonary edema
Symptoms peak at 60-90 minutes
Duration: 1-2 days

Differential Diagnosis

Marine toxins and envenomations

Toxins
- Ciguatera
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
Stingers
- Stingray injury
Venomous fish (catfish, zebrafish, scorpion fish, stonefish)
- Cone shells
- Lionfish
- Sea urchins
Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
  - Box jellyfish
  - Sea wasp
- Portuguese man-of-war
- Sea anemones
Phylum porifera (sponges)
Bites

Evaluation

Clinical diagnosis, no specific testing available
Consider radiography as retained foreign bodies are common[1]

Management

Clean wound, update tetanus, remove retained tissue
One fifth of wounds develop local infection, but prophylactic antibiotics remain controversial [2]
Immerse extremity in hot water (45 C) for 30-60 minutes
Stonefish envenomations with severe toxicity can be treated with antivenin obtained through poison control

Disposition

See Also

Marine toxins and envenomations

References

- Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.
- Hobday D, Chadha P, Din AH, Geh J. Denaturing the Lionfish. Eplasty. 2016 May 23;16:ic20. PMID: 27298709; PMCID: PMC4892334.

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