Stinging Fishes

A recent article published in the Journal of Heredity calls our attention to the extraordinary number of venomous spined fishes that inhabit the oceans. This has been a clinical area of special interest to me for nearly 30 years, and one in which I have acquired some expertise. The treatment of venomous fish stings is unique and not always well known by the lay public, or indeed, by medical practitioners.

In the Journal of Heredity article, Dr. William Smith and Ward Wheeler, a curator at the American Museum of Natural History, suggest that there are at least 1,200 species of venomous fishes. This was accomplished by comparing DNA sequences from 233 known venomous species and then creating a new family tree for spiny-rayed fishes, such as lionfishes, scorpionfishes, and stonefishes. As I have maintained for years, the stings from many other fishes, such as surgeonfishes, rabbitfishes, and stargazers, are also painful (and thus, persumably induced by venom). Indeed, if one is punctured by the "prongs" near the head of a spiny lobster, the wound may burn and throb way out of proportion to the magnitude of the wound. Is this another venomous species? Dr. Smith took his observations and dissected more than 100 fish species not previously identified as venomous, and in 61 of these, discovered anatomy that suggested a venomous nature.

The clinical observation is that the most consistently effective therapeutic intervention in the field is immersion into hot water ("to tolerance") no warmer than 45 degrees C or 113 degrees F. We don't know why this relieves the pain - perhaps it is due to inactivation of protein components of the venom, or perhaps the warmth simply interrupts pain pathways conducted by the nervous system. However, it often works, and should be used in preference to other less-effective folk remedies, such as urinating on wounds or applying vinegar or rubbing alcohol (the latter two are often effective, however, for jellyfish stings). For stings from species with less potent (pain-producing) venom (such as lionfishes), hot water immersion may work well. However, if a sting is from a more potent Indo-Pacific scorpionfish or the dreaded stonefish, it may be ineffective. In that case, the victim requires more agressive pain management.

Tags: venomous fishes, lionfish, scorpionfish, stonefish, medical, physician, health, wilderness medicine, outdoor medicine, healthline

photo by Paul Auerbach

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