Identification and Management of Marine Envenomations in Pediatric Patients

Points & Pearls Excerpt

• The pediatric population is at higher risk for serious reactions to marine envenomations.
• Prompt expert consultation with a toxicologist or Poison Control services is recommended to prevent morbidity and mortality.
• See Table 1 and Table 2 for the presentation of common and life-threatening marine envenomations.
• Basic laboratory evaluation (complete blood cell count and comprehensive metabolic panel) should be obtained for cases with systemic symptoms. For sea snake bites, also include creatine kinase and coagulation studies.
• If there is concern for a retained foreign body, x-ray or ultrasound are initial imaging choices. If the results of those tests are negative and clinical suspicion of foreign body is high, a computed tomography scan or magnetic resonance imaging should be obtained.

Most Important References

• Currie BJ. Marine antivenoms. J Toxicol Clin Toxicol. 2003;41(3):301-308. (Review article)
• Ward NT, Darracq MA, Tomaszewski C, et al. Evidence-based treatment of jellyfish stings in North America and Hawaii. Ann Emerg Med. 2012;60(4):399-414. (Review article)
• Li L, McGee RG, Isbister G, et al. Interventions for the symptoms and signs resulting from jellyfish stings. Cochrane Database Syst Rev. 2013(12):CD009688. (Review article; 7 tri-als, 435 participants)
• Loten C, Stokes B, Worsley D, et al. A randomised controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust. 2006;184(7):329- 333. (Randomized controlled trial; 96 patients)
• Thomas CS, Scott SA, Galanis DJ, et al. Box jellyfish (Carybdea alata) in Waikiki: their influx cycle plus the analgesic effect of hot and cold packs on their stings to swimmers at the beach: a randomized, placebo-controlled, clinical trial. Hawaii Med J. 2001;60(4):100-107. (Randomized, placebo-controlled, clinical trial; 127 patients)