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Stonefish sting

Definition

Stonefish are members of the family Scorpaenidae, or scorpion fish. The family also includes zebrafish and lionfish. These fish are very good at hiding in their surroundings. The fins of these prickly fish carry toxic venom. This article describes the effects of a sting from this kind of fish.

This article is for information only. DO NOT use it to treat or manage an actual stonefish sting. If you or someone you are with is stung, call your local emergency number (such as 911), or your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States.

Poisonous Ingredient

Stonefish venom is toxic.

Where Found

Venomous stonefish and related sea animals live in tropical waters, including off the warm coasts of the United States. They are also considered prized aquarium fish, and are found worldwide in aquariums.

Symptoms

A stonefish sting causes intense pain and swelling at the site of the sting. Swelling can spread to an entire arm or leg within minutes.

Below are symptoms of a stonefish sting in different parts of the body.

AIRWAYS AND LUNGS

  • Difficulty breathing

HEART AND BLOOD

  • No heartbeat
  • Irregular heartbeat
  • Low blood pressure
  • Collapse (shock)

SKIN

  • Bleeding.
  • Severe pain at the site of the sting. Pain can spread quickly into the entire limb.
  • Lighter color of the area around the sting.
  • Change to the color of the area as oxygen decreases.

STOMACH AND INTESTINES

  • Abdominal pain
  • Diarrhea
  • Nausea and vomiting

NERVOUS SYSTEM

  • Anxiety
  • Delirium (agitation and confusion)
  • Fainting
  • Fever (from infection)
  • Headache
  • Muscle twitching
  • Numbness and tingling, spreading out from the site of the sting
  • Paralysis
  • Seizures
  • Tremors (shaking)

Home Care

Seek medical help right away. Contact your local emergency services. Wash the area with fresh water. Remove any debris, such as sand, at the wound site. Soak wound in the hottest water the person can tolerate for 30 to 90 minutes.

Before Calling Emergency

Have this information ready:

  • Person's age, weight, and condition
  • Type of fish, if known
  • Time of the sting
  • Location of the sting

Poison Control

Your local poison center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

What to Expect at the Emergency Room

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. The wound will be soaked in a cleaning solution and any remaining debris will be removed. Symptoms will be treated as appropriate. Some or all of the following procedures may be performed:

  • Blood and urine tests
  • Breathing support, including oxygen, tube through the mouth into the throat, and breathing machine (ventilator)
  • ECG (electrocardiogram, or heart tracing)
  • Fluids through a vein (by IV)
  • Medicine, called antiserum, to reverse the effect of the venom
  • Medicine to treat symptoms
  • X-rays

Outlook (Prognosis)

Recovery usually takes about 24 to 48 hours. Outcome often depends on how much venom entered the body, the location of the sting, and how soon the person received treatment. Numbness or tingling may last for several weeks after the sting. Skin breakdown is sometimes severe enough to require surgery.

A puncture to the person's chest or abdomen may lead to death.

References

Elston DM. Bites and stings. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology, 4th ed. Philadelphia, PA: Elsevier; 2018:chap 85.

Auerbach PS, DiTullio AE. Envenomation by aquatic vertebrates. In: Auerbach PS, Cushing TA, Harris NS. eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 75.

Otten EJ. Venomous animal injuries. In: Walls RM, Hockberger RS, Gausche-Hill M, eds. Rosen's Emergency Medicine: Concepts and Clinical Practice. 9th ed. Philadelphia, PA: Elsevier; 2018:chap 55.

Last reviewed July 20, 2021 by Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team..

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