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Global warming and the Jellyfish toxidrome

  1. Global Warming and the Irukandji Toxidrome Dr Alice Young CODA ZERO 17th February 2021
  2. Irukandji Jellyfish – Carukia Barnesi
  3. Distribution eATLAS (NESP)
  4. Irukandji Syndrome Initial: Mild sting Minimal or absent dermal marking 5-120 (30-40) min later: Severe Pain Nausea and vomiting Headache SOB Impending doom Hypertension Tachycardia
  5. Cardiac Complications Cardiogenic shock APO Tachyarrhythias Takatsubo Tiong 2009, Eur J Echocardiogr.
  6. Mitral Valve, Time Vs E-Peak Velocity (%E-PV), A-Peak Velocity (%A-PV) for CBV. Error bars are 95% confidence limits. Aortic Valve, Time vs %HR, %SD and %CO for ) CBV.%CO ¼ 100((HRxSDxθ)/HRxSDxθ)), whereθ is the cross-sectional area of the aortic valve. Error bars are 95% confidence limits.
  7. Neurological Complications Intracranial Haemorrhage Death Fenner & Hadcock. 2002. MJA.
  8. Management – First Aid ARC Guidelines Remove from the water/wetsuit Vinegar 30 seconds Seawater or saline Remove any tentacles Ice pack No antivenom
  9. Management – In Hospital Clinical Toxicology Handbook (Murray, Little, Pascu, Hoggett) Resuscitation and supportive care Specific treatment Pain – fentanyl (0.5-1.0 mcg/kg/dose) q10min until analgesia achieved (up to 300mcg may be required) – alternative is morphine (may need PCA) Nausea – promethazine 25mg or 0.5mg/kg in children Hypertension – if refractory to analgesia – GTN infusion (50mg/100ml at 6mlmin; 1- 4mcg/kg/min in children) for SBP <160mmHg Investigations Exclude alternatives and assess complications 12 lead ECG – ischaemia and T wave abnormalities CXR – pulmonary oedema If HD unstable – FBC, UEC, ECG, tn, CK every 8 hours Echo if pulmonary oedema or hypotension CTB
  10. Management – In Hospital Consider alternative diagnoses Disposition EMU/WARD/ICU Home
  12. References Tiong (2009) IrukandjiSC, Irukandji syndrome, catecholamines, and mid-ventricular stress cardiomyopathy. European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology,2009},{10 2},334-6 } } Seymour, J., Saggiomo, S., Lam, W., Pereira, P., & Little, M. (2020). Non-invasive assessment of the cardiac effects of Chironex fleckeri and Carukia barnesi venoms in mice, using pulse wave doppler. Toxicon, 185, 15–25. doi:10.1016/j.toxicon.2020.06.018 Huynh, T. T., Pereira, P., Mulcahy, R., Cullen, P., Seymour, J., Carrette, T., & Little, M. (2003). Severity of Irukandji syndrome and nematocyst identification from skin scrapings. Medical Journal of Australia, 178(1), 38–41. doi:10.5694/j.1326-5377.2003.tb05041.x Winkel KD, Tibballs J, Molenaar P, Lambert G, Coles P, Ross-Smith M, Wiltshire C, Fenner PJ, Gershwin LA, Hawdon GM, Wright CE, Angus JA. Cardiovascular actions of the venom from the Irukandji (Carukia barnesi) jellyfish: effects in human, rat and guinea-pig tissues in vitro and in pigs in vitro. Clin Exp Pharmacol Physiol. 2005 Sep;32(9):777-88. doi: 10.1111/j.1440-1681.2005.04258.x. PMID: 16173936. McCullagh N, Pereira P, Cullen P, Mulcahy R, Bonin R, Little M, Gray S, Seymour J. Randomised trial of magnesium in the treatment of Irukandji syndrome. Emerg Med Australas. 2012 Oct;24(5):560-5. doi: 10.1111/j.1742-6723.2012.01602.x. Epub 2012 Sep 11. PMID: 23039299. Rathbone J, Franklin R, Gibbs C, Williams D. Review article: Role of magnesium sulphate in the management of Irukandji syndrome: A systematic review. Emerg Med Australas. 2017 Feb;29(1):9-17. doi: 10.1111/1742-6723.12694. Epub 2016 Oct 17. PMID: 27748058. Carrette TJ, Seymour JJ. Long-term analysis of Irukandji stings in Far North Queensland. Diving Hyperb Med. 2013 Mar;43(1):9-15. PMID: 23508658. Fenner PJ, Hadok JC. Fatal envenomation by jellyfish causing Irukandji syndrome. Med J Aust. 2002 Oct 7;177(7):362-3. PMID: 12358578. Gershwin, Lisa-ann, Dr ; Thomas, Linda, Ms ; Condie, Scott, Dr ; Richardson, Anthony, Prof (2019): Venomous Jellyfish Database (sting events and specimen samples – November 2018) (NESP 2.2.3, CSIRO). eAtlas.dataset.