Stingray Envenomation Treatment Recommendations

Abstract

INTRODUCTION ach year, millions pursue work and leisure activities in the ocean. Thousands of people Eunknowingly step into the ocean for wading or swimming and receive a barbed sting from a normally docile, frightened stingray. This wellcamouflaged creature from the Chondrichthyes class, which includes sharks and skates, lives in temperate oceans around the world. Stingrays are also found in freshwater river systems. In the coastal waters of the United States there are approximately 11 species of stingrays and about 150 worldwide, which are divided into 2 superfamilies, the Dasytoidea, or true stingrays, and the Myliobatoidea. Their sizes range from the size one’s palm to 6.5 feet (2 meters) and weigh up to 800 pounds (350 kg). The longer the stingray spine and the more distally located the spine is on the whiplike tail, the greater the danger to humans from stingray spine injuries. Stingrays are not to be confused with the Manta Ray, which is harmless and does not have a barbed tail. Of these 2 families, the majority of venomous marine stings are from 2 species. From the West Coast there is the Urolophus halleri, also commonly known as the round stingray, with an average length of up to 24 inches, and along the South-East coast there is the southern stingray, Dasyatis Americana, with lengths up to 79 inches. Scuba divers and snorkelers are fortunate when they come across the beautiful stingray. This creature is easily identifiable as it glides through the water while gently moving its dorsoventrally flattened body to feed on shrimp and small fish. Well adapted to its habitat, the stingray can blend easily into the sand. When the stingray is stepped on or encounters danger, it raises its tail, and “strikes” with its sharp pointed spine. This spine is composed of a bonelike cartilaginous material with unique histologic architecture and a venom-delivery system that can be seen on X-ray (Figure 1). On the underside of the spine are venom-secreting glandular cells. The stingray’s sheath covering breaks apart as it enters the