Irukandji syndrome - Revision history

Athorne: /* Management */

2021-07-31T02:42:07Z

Management

← Revisión anterior		Revisión del 02:42 31 jul 2021
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	==Management==		==Management==
	*Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>		*Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>
			*Fentanyl IV or other opiate for pain.
	*IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids		*IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids
	*Hypertension should be treated with short-acting titratable medications (eg., phentolamine, esmolol, nicardipine, nitroprusside) due to potential for hypotension in the later stages of toxicity		*Hypertension should be treated with short-acting titratable medications (eg., nitroglycerin, phentolamine, esmolol, nicardipine, nitroprusside) due to potential for hypotension in the later stages of toxicity

	==Disposition==		==Disposition==

Athorne: /* Clinical Features */

2021-07-31T02:40:16Z

Clinical Features

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	==Clinical Features==		==Clinical Features==
	*Rare but potentially fatal ~~complications can manifest in diverse ways:~~		*Rare but potentially fatal complication. It often involves intense pain, diffuse muscle cramps, vasconstriction and marked hypertension due to a catacholamine surge.
	**Myalgias		**Beware of [[hypertensive emergency]]: Look for signs of end organ damage (ie ACS, CHF, intracranial hemorrhage, renal injury)
	**Back pain
	**Chest pain
	**Abdominal pain
	**Nausea and ~~vomiting~~
	**~~Diaphoresis~~
	**Hypertensive crisis
	**Cardiogenic pulmonary edema
	**Intracranial hemorrhage
	**Death

	==Differential Diagnosis==		==Differential Diagnosis==

Rossdonaldson1: /* See Also */

2021-07-24T12:39:45Z

Rossdonaldson1: /* Background */

2021-07-24T12:39:25Z

Background

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	==Background==		==Background==
	*Caused by certain jellyfish from the Cubozoa class (box jellyfish) species		[[File:Avispa marina cropped.png\|thumb\|Box jellyfish]]
			[[File:Nematocyst discharge.png\|thumb\|Nematocyst stages of discharge]]
			*Caused by certain jellyfish from the Cubozoa class ([[box jellyfish]]) species
	*Usually develops within 2 hours of envenomation & can last up to 2 days <ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>		*Usually develops within 2 hours of envenomation & can last up to 2 days <ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>
	* The sympathomimetic-like manifestations are due to the venom, which is proteinaceous and contains a neural sodium channel activator.		* The sympathomimetic-like manifestations are due to the venom, which is proteinaceous and contains a neural sodium channel activator.

Rossdonaldson1 at 12:38, 24 July 2021

2021-07-24T12:38:52Z

← Revisión anterior		Revisión del 12:38 24 jul 2021
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	==~~'''~~Background~~'''~~==		==Background==
	*Caused by certain jellyfish from the Cubozoa class (box jellyfish) species		*Caused by certain jellyfish from the Cubozoa class (box jellyfish) species
	*Usually develops within 2 hours of envenomation & can last up to 2 days <ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>		*Usually develops within 2 hours of envenomation & can last up to 2 days <ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>
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	**Acts on the same sodium channels that are sensitive to tetrodotoxin, causing the release of catecholamines, particularly norepinephrine and epinephrine, and also direct vasoconstrictor effects.<ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>		**Acts on the same sodium channels that are sensitive to tetrodotoxin, causing the release of catecholamines, particularly norepinephrine and epinephrine, and also direct vasoconstrictor effects.<ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>

	==~~'''~~Clinical Features~~'''~~==		==Clinical Features==
	*Rare but potentially fatal complications can manifest in diverse ways:		*Rare but potentially fatal complications can manifest in diverse ways:
	**Myalgias		**Myalgias

Rossdonaldson1: /* Management */

2021-07-24T12:38:32Z

Management

← Revisión anterior		Revisión del 12:38 24 jul 2021
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	*Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>		*Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>
	*IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids		*IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids
	*Hypertension should be treated with short-acting titratable medications (eg., phentolamine, esmolol, nicardipine, nitroprusside) ~~d/t~~ potential for hypotension in the later stages of toxicity		*Hypertension should be treated with short-acting titratable medications (eg., phentolamine, esmolol, nicardipine, nitroprusside) due to potential for hypotension in the later stages of toxicity

	==Disposition==		==Disposition==

Rossdonaldson1: /* Background */

2021-07-24T12:37:53Z

Background

← Revisión anterior		Revisión del 12:37 24 jul 2021
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	*Caused by certain jellyfish from the Cubozoa class (box jellyfish) species		*Caused by certain jellyfish from the Cubozoa class (box jellyfish) species
	*Usually develops within 2 hours of envenomation & can last up to 2 days <ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>		*Usually develops within 2 hours of envenomation & can last up to 2 days <ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>
	* The sympathomimetic-like manifestations are due to the venom, which is proteinaceous and contains a neural sodium channel activator. **Acts on the same sodium channels that are sensitive to tetrodotoxin, causing the release of catecholamines, particularly norepinephrine and epinephrine, and also direct vasoconstrictor effects.<ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>		* The sympathomimetic-like manifestations are due to the venom, which is proteinaceous and contains a neural sodium channel activator.
			**Acts on the same sodium channels that are sensitive to tetrodotoxin, causing the release of catecholamines, particularly norepinephrine and epinephrine, and also direct vasoconstrictor effects.<ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>

	=='''Clinical Features'''==		=='''Clinical Features'''==

Rossdonaldson1: /* Management */

2021-07-24T12:37:17Z

Management

← Revisión anterior		Revisión del 12:37 24 jul 2021
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	*CT imaging of the brain in cases of headache or acute encephalopathy<ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>		*CT imaging of the brain in cases of headache or acute encephalopathy<ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>

	==~~'''~~Management~~'''~~==		==Management==
	*Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>		*Manage pain with 4-5% acetic acid (household vinegar) & Hot water immersion (111-114F)<ref> Hauglid, C., Kiel, J., & Schmidt, A. (2021, April 23). Emergen-Sea Medicine: Overview of Marine Envenomations - Page 4 of 5. ACEP Now. https://www.acepnow.com/article/emergen-sea-medicine-overview-of-marine-envenomations/4/.</ref>
	*IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids		*IV magnesium sulfate (0.2mmol/kg, max 10mmol in adults) given as a bolus over 5-15 minutes for pain refractory to opioids
	*Hypertension should be treated with short-acting titratable medications (eg., phentolamine, esmolol, nicardipine, nitroprusside) d/t potential for hypotension in the later stages of toxicity		*Hypertension should be treated with short-acting titratable medications (eg., phentolamine, esmolol, nicardipine, nitroprusside) d/t potential for hypotension in the later stages of toxicity

			==Disposition==

			==See Also==

			==External Links==

	==References==		==References==

Rossdonaldson1: /* Differential Diagnosis */

2021-07-24T12:36:11Z

Differential Diagnosis

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	**Death		**Death

	===Differential Diagnosis===		==Differential Diagnosis==
	*[[Marine ~~toxins and envenomations]]~~		{{Marine envenomation DDX}}
	**Toxins ([[ciguatera]], [[neurotoxic shellfish poisoning]], [[paralytic shellfish poisoning]], [[scombroid]], [[tetrodotoxin]]
	**Stingers ([[stingray injury]])
	**Venomous fish (catfish, zebrafish, scorpion fish, stonefish, [[cone shells]], [[Lionfish envenomation~~\|lionfish]], [[sea urchins]])~~
	**[[Nematocysts]] ([[coral reef]], [[Fire coral contact\|fire coral]], [[box jellyfish]], [[Sea wasp sting\|sea wasp]], [[portuguese man-of-war]], [[sea anemones]])
	**[[Phylum porifera]] (sponges)
	**Bites ([[alligator and crocodile attacks\|alligator/crocodile]], [[octopus bite\|octopus]], [[shark bite\|shark]])

	==Evaluation==		==Evaluation==

Jonrako at 22:41, 22 July 2021

2021-07-22T22:41:34Z

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	**Bites ([[alligator and crocodile attacks\|alligator/crocodile]], [[octopus bite\|octopus]], [[shark bite\|shark]])		**Bites ([[alligator and crocodile attacks\|alligator/crocodile]], [[octopus bite\|octopus]], [[shark bite\|shark]])

	==Evaluation== <ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>		==Evaluation==
	*~~Electrocardiogram~~		*EKG
	*~~Cardiac enzymes~~		*Troponin & ProBNP
	*~~Chemistry~~		*CBC
	*~~Blood count~~		*CMP
	*Liver enzymes
	*Lipase		*Lipase
	*Chest X-ray		*Chest X-ray
	*Bedside echocardiogram if acute heart failure is suspected		*CT imaging of the brain in cases of headache or acute encephalopathy<ref>Kong EL, Nappe TM. Irukandji Syndrome. [Updated 2021 May 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK562264/</ref>
	*CT imaging of the brain in cases of headache or acute encephalopathy

	=='''Management'''==		=='''Management'''==

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	==See Also==		==See Also==
			*[[Box jellyfish]]

	==External Links==		==External Links==