Irukandji syndrome

Q: What is Irukandji syndrome?

Answer: Systemic envenomation from the sting of some Jellywish species

Systemic envenomation from some jellyfish species can be fatal. It starts as mild to moderate painful local stinging sensation but within minutes can set into waves of severe generalized back, chest, and abdominal pain, vomiting, sweating, agitation, severe hypertension, tachycardia, myocardial injury (MI), pulmonary edema (PE), and intracranial hemorrhage (ICH).

Patients need management on various fronts. Pain control with opioids, wound irrigation with vinegar, removing any jellyfish tentacles if found, hot packs at the site (or immersion in hot water).

The underlying pathology is catecholamine release leading to severe hypertension resulting in MI, PE and ICH. Benzodiazepines may help. For BP control, nitroglycerin, sodium nitroprusside, or phentolamine can be utilized.

Magnesium has been proposed, but counting risk vs. benefit is not recommended.

#toxicity

References:

1. Cegolon L, Heymann WC, Lange JH, Mastrangelo G. Jellyfish stings and their management: a review. Mar Drugs 2013; 11:523.

2. Macrokanis CJ, Hall NL, Mein JK. Irukandji syndrome in northern Western Australia: an emerging health problem. Med J Aust 2004; 181:699.

3. Lippmann JM, Fenner PJ, Winkel K, Gershwin LA. Fatal and severe box jellyfish stings, including Irukandji stings, in Malaysia, 2000-2010. J Travel Med 2011; 18:275.

4. Fenner PJ, Hadok JC. Fatal envenomation by jellyfish causing Irukandji syndrome. Med J Aust 2002; 177:362.