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Irukandji syndrome – the swarm hits Broome

We had our first ‘swarm’ of Irukandji syndrome victims for the season last week – with associated media frenzy!

For those of you who are not familiar with Irukandji syndrome – it is a jellyfish envenomation, the villain is the Carukia barnesi, a tiny little jelly fish with just 4 tentacles that packs a mighty punch!  It really is a very unpleasant syndrome:

  • Symptoms onset 20 minutes to hours after a sting [after leaving the beach etc]
  • the sting is often invisible or a small wheal
  • symptoms: well imagine a bloke got pregnant, developed pre-eclampsia and went into labour
    • Severe pain that spreads all over the body, hypertension, vomiting, sweating and “a sense of doom”
  • Severe cases: acute pulmonary oedema, off the chart hypertension => intracerebral bleed (2 cases of death by this cause)

Mike Cadogan (LITFL founder) knows the toxicology of this much better than I do – so if you are interested read the posts at LITFL (below)

So how do I treat this syndrome?

  • Lots of fentanyl.  I find intranasal fentanyl great for kids – the milder cases you can manage with a few doses and no need to further upset the usually inconsolable child with a needle
  • IV fentanyl if required, sometimes even a PCA for the prolonged case with significant pain.
  • If you can get the pain under control, then I have not seen a lot of persistent hypertension in the dangerous range
  • IV GTN infusion can be used to manage the catecholamine driven hypertension
  • Magnesium is something that is done a lot in some centres – it is purported to decrease pain significantly and we know it can help drop the BP.  Personally I have not had to go to the second line of therapy in the last few years – so I have not much experience with it – but I think it makes sense if you are not winning with good doses of opiates
  • Other than that the management is supportive – control the BP and watch for neurology and signs of APO.

Oh, and the name – Irukandji – it is not the name of the jelly fish, it is great for Scrabble.  It is the name of the traditional custodians of the coastal lands north of Cairns, sometimes Yirrganydji is the spelling.

So, remember your swimmer suit and 2 litres of vinegar when you go swimming in the north of Australia

If you want to know more about the things that sting in WA – check out this publication from the WA Museum

–  Casey

Comments

  1. Minh Le Cong says:

    love the post! yes this is the time of year up north where tourists turn up to the ED with this..most locals learn to avoid the sea at this time..certainly I do !!
    About the Magnesium treating the syndrome, enthusiasm for this has waned up in FNQ. it seems to work unpredictably..good results in some, nothing in others. we use fentanyl infusion and PCA quite early if pain is not settled with first line measures. Dont forget troponin testing. Positive teste get admitted and observed in HDU, as some develop APO.
    great analogy of pre eclampsia and labour…maybe thats why the Magnesium works even if occasionally !!!

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