Scorpionfish, Lionfish, and Stonefish Poisoning

• Scorpionfish, lionfish, and stonefish are all poisonous fish that live in tropical and temperate oceans, especially the Red Sea and Indian and Pacific oceans.
• They all have erectile spines on their dorsal, anal, and pelvic fins.
• Because these fish are not aggressive, contact with them and the poisonings that result are usually accidental.
• Contact with the sharp venomous fin ray spines that are covered with mucus-containing poison on lionfish causes mild envenomation and similar contact with spines on camouflaged scorpionfish causes moderate to severe envenomation.
• The motionless stonefish, when contacted, causes severe to life-threatening neurotoxin poisoning and is likened to cobra venom in toxicity.

Poisons from these fish spines, in general, may produce the following symptoms, which may vary from person to person, and their intensity is related to the amount of toxin the person is exposed to.

• Intense throbbing pain peaks in 1 to 2 hours and lasts 12 hours. Pain may be so severe as to cause hallucinations.
• Redness, bruising, swelling, numbness, tingling, blisters or vesicles, and tissue shedding at the wound site may occur.
• Severe reactions include nausea, vomiting, abdominal cramps, tremors, abnormal heart rhythms, weakness, headache, diarrhea, slow heart rate (bradycardia), shortness of breath, seizures, decreased blood pressure, fainting, and paralysis. Death may occur.

• Remove the exposed person from the water to prevent drowning.
• Immerse the wound for 30 to 90 minutes in water as hot as the poisoned person can tolerate (up to 140 F or 60 C) because the poisons are heat-sensitive. Repeat as necessary to control pain.
• Local or regional anesthetics (blocks) may be useful in some patients for pain control
• Use tweezers to remove any spines in the wound using caution to not squeeze venom glands that may have broken off in the wound with the spine. It is rare for a spine to break off in the wound. Use caution, wear gloves to avoid self-inoculation during spine removal.
• Scrub the wound with soap and water. Then flush the affected area with fresh water.
• There is antivenom available for stonefish envenomations.
• Do not apply tape to close the wound as this may increase the risk of infection.
• Patients may need a tetanus booster; this is usually recommended for all patients with this type of poisoning.

All cases of scorpionfish, lionfish, and stonefish poisoning require medical attention to ensure no foreign material remains in the wound and to provide symptomatic care as needed.