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weakness . Creatine kinase is elevated
because of muscle injury , and in
|
A |
B |
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severe cases , rhabdomyolysis is complicated |
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by hyperkalaemia , hypocalcaemia |
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and acute kidney injury , with |
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associated myoglobinuria . |
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Treatment is similar to that for |
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Australian terrestrial snakes . First |
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aid consists of a pressure bandage |
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with immobilisation of the extremity |
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and whole body . Antivenom is |
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the mainstay of treatment for systemic |
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envenomation , and a small |
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case series supports its effectiveness . 9 Use only sea snake antivenom and not any other snake antivenom . |
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In severe cases , supportive treatment |
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is important for electrolyte |
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abnormalities and acute kidney |
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injury . |
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|
Blue-ringed octopus
Blue-ringed octopuses occur in tidal
|
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areas and rock pools around the coast |
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of Australia . They are often well camouflaged |
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until they are disturbed — when their rings change colour dramatically . Their saliva contains tetrodotoxin that is injected when the octopus bites . Bites almost always occur when the creature is picked up and irritated . |
Figure 5 . Stingray injury to the dorsum of the foot .
A . Day one .
B . Day three .
|
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Most bites are painless and only |
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recognised because there is local bleeding . Most cases result in only |
A |
B |
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minor effects , with localised or |
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regional numbness and paraesthesia |
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. Systemic envenomation is characterised |
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by flaccid paralysis , which |
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is identical to tetrodotoxin poisoning |
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and described later . Treatment is |
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early basic life support for respiratory |
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paralysis and immediate transport to |
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hospital . Pressure immobilisation is recommended but should not prevent basic life support or transport . There is |
Figure 6 . Sea urchin injury to the foot . |
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|
no antidote for tetrodotoxin , so treatment is supportive , with mechanical ventilation .
Sponges
Sponge injuries differ from other marine injuries because they are
|
A . This shows the entry wounds .
B . An X-ray of the largest spine before removal .
|
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contact skin reactions rather than penetrating injuries . Injuries are uncommon , with only some species , |
Ciguatera
Ciguatera is by far the most common
|
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such as fire sponges , having toxic |
marine poisoning : it is an important |
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secretions that cause more severe effects . 10 The clinical effects of most sponge injuries tend to be minor , |
health condition in the Indo-Pacific and Caribbean regions , where seafood is the major dietary source of protein . |
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with local paraesthesia , numbness , |
It is endemic in parts of northern Aus- |
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itchiness and mild stinging pain . |
tralia , but with modern freezer trans- |
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The effects usually last hours but , in |
port and international travel , it can |
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some cases , may persist for 2-3 days . |
occur in any part of Australia . |
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Most cases only result in erythema , with occasional development of vesicles and blistering . |
Ciguatera results from the ingestion of ciguatoxins , which are produced by small marine creatures |
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Fire sponges , however , differ |
( dinoflagellates : Gambierdiscus tox- |
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because they cause moderate to |
icus ) and then accumulate in larger |
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severe delayed effects that can pres- |
tropical reef fish as they travel up the |
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ent up to 2-3 weeks after contact , |
food chain . Fish typically implicated |
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with painful swelling and erythema , |
are Spanish mackerel , mackerel , bass , |
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followed by desquamation ( see fig- |
coral trout , moray eels and species |
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ure 7 ). Wash the contact area as soon |
of cod and emperors . Unfortunately , |
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as possible , and treat symptomati- |
there is no way to identify if a fish |
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cally with analgesia and antihista- |
contains ciguatoxins , including by |
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|
mines . The effects resolve over days to weeks .
MARINE POISONING
MARINE poisoning occurs following
|
the taste of the fish . Fish in different regions may or may not be affected .
CLINICAL EFFECTS The clinical effects differ between the
|
Figure 7 . Delayed skin reaction to a fire sponge contact . |
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the ingestion of marine invertebrates |
Indo-Pacific and the Caribbean . In the |
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( for example , shellfish ) or vertebrates |
Indo-Pacific , including Australia , cig- |
Neurological effects are generally |
paraesthesia , and numbness . Cold |
are described , but these are poorly |
( large fish ) where these animals have |
uatera causes both gastrointestinal |
delayed and develop over a period |
allodynia is often incorrectly referred |
defined and present with less spe- |
accumulated toxins from the envi- |
and neurological effects . The gastro- |
of up to 24 hours . The combination |
to as heat reversal but is instead the |
cific systemic effects , such as fatigue , |
ronment via the food chain . Gastro- |
intestinal effects precede the neu- |
of the early gastrointestinal effects |
abnormal and unpleasant sensation |
loss of energy and depression , as well |
intestinal and neurotoxic effects are |
rological effects and may initially be |
and delayed neurological effects is |
when touching cold objects , such as |
as gastrointestinal and neurological |
the most common clinical manifestations . 1 Marine poisonings , like other causes of food poisoning , are notifia- |
like any food poisoning illness , with vomiting , crampy abdominal pain and diarrhoea . These symptoms may |
the hallmark of the poisoning . The characteristic neurological effects are a sensory polyneuropathy with |
water . More general systemic effects include myalgia , arthralgia and pru- |
effects . The diagnosis of ciguatera is clinical , based on the character- |
ble diseases in Australia . |
resolve after about 12 hours . |
cold allodynia , distal and perioral |
ritus . Sub-acute and chronic forms |
istic combination of the PAGE 24 |