Skip to Main Content

We have a new app!

Take the Access library with you wherever you go—easy access to books, videos, images, podcasts, personalized features, and more.

Download the Access App here: iOS and Android. Learn more here!


  • 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.

As more humans venture into aquatic environments for recreational activities, vacations, exotic destinations, and an improved quality of life, the opportunity for children to encounter venomous marine life that hide in reefs and shallow marine waters increases.1,2 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.1,3 Hazardous marine life can be classified into four major groups:

  • Venomous bites and stings, such as those inflicted by scorpion fish and the Portuguese man-o’war.

  • Shock injuries, such as from electric eels.

  • Traumatogenic bites, such as from sharks and barracudas.

  • Toxic ingestions or fish poisoning.4

Toddlers are most likely to be envenomed in shallow waters and are typically unable to give a detailed or reliable history. Young children may either step on poisonous marine animals or handle them, resulting in extremity stings. Adolescents are more adventurous and frequent deeper waters as surfers,5 ocean swimmers, snorkelers, and scuba divers.6 This age group is also more susceptible to intoxication with ethanol or recreational drugs.1


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. Even in colder marine regions such as Scandinavia, jellyfish envenomations are encountered.7 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 m in length (Fig. 136-1). The deadliest and most venomous of coelenterates is the box jellyfish or sea wasp of Australia (Fig. 136-2).8–11

FIGURE 136-1.

Portuguese man-o’war.

FIGURE 136-2.

Box jellyfish or sea wasp.


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 ...

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.