From #CodaZero Live, Alice Young provides a brief update on the presentation, complications and management of Irukandji syndrome; and why we all need to know about it.

1. Global Warming and
the Irukandji
Toxidrome
Dr Alice Young
CODA ZERO 17th February 2021

2. Irukandji Jellyfish – Carukia Barnesi

3. Distribution
eATLAS (NESP)
https://eatlas.org.au/data/uuid/16904861-53e6-4123-a7bb-781f2429629f

5. Irukandji Syndrome
Initial:
Mild sting
Minimal or absent dermal marking
5-120 (30-40) min later:
Severe Pain
Nausea and vomiting
Headache
SOB
Impending doom
Hypertension
Tachycardia
https://www.ambulance.qld.gov.au/docs/QAS-Irukandji-jellyfish.pdf

6. Cardiac Complications
Cardiogenic shock
APO
Tachyarrhythias
Takatsubo
Tiong 2009, Eur J Echocardiogr.

8. Mitral Valve, Time Vs E-Peak Velocity (%E-PV), A-Peak Velocity
(%A-PV) for CBV. Error bars are 95% confidence limits.
Aortic Valve, Time vs %HR, %SD and %CO for ) CBV.%CO ¼
100((HRxSDxθ)/HRxSDxθ)), whereθ is the cross-sectional area of the aortic
valve. Error bars are 95% confidence limits.

9. Neurological Complications
Intracranial Haemorrhage
Death
Fenner & Hadcock. 2002. MJA.

10. Management – First Aid
ARC Guidelines
Remove from the water/wetsuit
Vinegar 30 seconds
Seawater or saline
Remove any tentacles
Ice pack
No antivenom

11. Management – In Hospital
Clinical Toxicology Handbook (Murray, Little, Pascu, Hoggett)
Resuscitation and supportive care
Specific treatment
Pain – fentanyl (0.5-1.0 mcg/kg/dose) q10min until analgesia achieved (up to 300mcg may be
required) – alternative is morphine (may need PCA)
Nausea – promethazine 25mg or 0.5mg/kg in children
Hypertension – if refractory to analgesia – GTN infusion (50mg/100ml at 6mlmin; 1-
4mcg/kg/min in children) for SBP <160mmHg
Investigations
Exclude alternatives and assess complications
12 lead ECG – ischaemia and T wave abnormalities
CXR – pulmonary oedema
If HD unstable – FBC, UEC, ECG, tn, CK every 8 hours
Echo if pulmonary oedema or hypotension
CTB

12. Management – In Hospital
Consider alternative diagnoses
Disposition
EMU/WARD/ICU
Home

13. QUESTIONS?

14. References
Tiong (2009) IrukandjiSC, Irukandji syndrome, catecholamines, and mid-ventricular stress cardiomyopathy. European journal of echocardiography : the journal of the
Working Group on Echocardiography of the European Society of Cardiology,2009},{10 2},334-6 } }
Seymour, J., Saggiomo, S., Lam, W., Pereira, P., & Little, M. (2020). Non-invasive assessment of the cardiac effects of Chironex fleckeri and Carukia barnesi venoms in
mice, using pulse wave doppler. Toxicon, 185, 15–25. doi:10.1016/j.toxicon.2020.06.018
Huynh, T. T., Pereira, P., Mulcahy, R., Cullen, P., Seymour, J., Carrette, T., & Little, M. (2003). Severity of Irukandji syndrome and nematocyst identification from skin
scrapings. Medical Journal of Australia, 178(1), 38–41. doi:10.5694/j.1326-5377.2003.tb05041.x
Winkel KD, Tibballs J, Molenaar P, Lambert G, Coles P, Ross-Smith M, Wiltshire C, Fenner PJ, Gershwin LA, Hawdon GM, Wright CE, Angus JA. Cardiovascular actions of
the venom from the Irukandji (Carukia barnesi) jellyfish: effects in human, rat and guinea-pig tissues in vitro and in pigs in vitro. Clin Exp Pharmacol Physiol. 2005
Sep;32(9):777-88. doi: 10.1111/j.1440-1681.2005.04258.x. PMID: 16173936.
McCullagh N, Pereira P, Cullen P, Mulcahy R, Bonin R, Little M, Gray S, Seymour J. Randomised trial of magnesium in the treatment of Irukandji syndrome. Emerg Med Australas. 2012
Oct;24(5):560-5. doi: 10.1111/j.1742-6723.2012.01602.x. Epub 2012 Sep 11. PMID: 23039299.
Rathbone J, Franklin R, Gibbs C, Williams D. Review article: Role of magnesium sulphate in the management of Irukandji syndrome: A systematic review. Emerg Med
Australas. 2017 Feb;29(1):9-17. doi: 10.1111/1742-6723.12694. Epub 2016 Oct 17. PMID: 27748058.
Carrette TJ, Seymour JJ. Long-term analysis of Irukandji stings in Far North Queensland. Diving Hyperb Med. 2013 Mar;43(1):9-15. PMID: 23508658.
Fenner PJ, Hadok JC. Fatal envenomation by jellyfish causing Irukandji syndrome. Med J Aust. 2002 Oct 7;177(7):362-3. PMID: 12358578.
Gershwin, Lisa-ann, Dr ; Thomas, Linda, Ms ; Condie, Scott, Dr ; Richardson, Anthony, Prof (2019): Venomous Jellyfish Database (sting events and specimen samples –
November 2018) (NESP 2.2.3, CSIRO). eAtlas.dataset. https://eatlas.org.au/data/uuid/16904861-53e6-4123-a7bb-781f2429629f
https://www.theexpressnewspaper.com.au/latest-news/state-of-north-queensland-one-step-closer
https://boxjellyfish.org/box-jellyfish-sting-symptoms/
https://web.archive.org/web/20091015142240/http://www.reef.crc.org.au//publications/brochures/documents/jellyfishNov04_web.pdf
https://www.abc.net.au/news/2019-11-10/irukandji-jellyfish-councils-monitoring-move-south/11678370