Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

all patients

1st line – observation

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ACUTE
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all patients
1st line – 

observation

All patients should be observed closely for several hours, as paralysis and respiratory arrest may occur suddenly. Patients can remain conscious even while paralysed.

If no symptoms develop within 6 hours of exposure, expert opinion suggests that patients can be discharged with strict return precautions.[34] If a patient develops any symptoms, they should return to hospital quickly and they should be monitored for at least 24 hours.

Plus – supportive care

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ACUTE
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all patients
Plus – 

supportive care

Treatment recommended for ALL patients in selected patient group

Supportive care is the mainstay of management. Several marine toxins produce rapidly progressive neurological deterioration, paralysis, loss of airway control, and loss of ventilation. Suspected or confirmed cases of marine toxin should be assessed and monitored for adequacy of airway-protective reflexes (gag and cough), control of oropharyngeal secretions, adequacy of oxygenation, and adequacy of ventilation.

Airway control and mechanical ventilation should be considered for any patient with upper airway compromise (from pharyngeal muscle paralysis), progressive paralysis, or a decline in ventilation.

There are no available effective antidotes for these marine neurotoxins.

Consider – activated charcoal

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ACUTE
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all patients
Consider – 

activated charcoal

Additional treatment recommended for SOME patients in selected patient group

Gastrointestinal decontamination with activated charcoal may reduce the absorption of toxins from the stomach and could reduce the severity of poisoning if used soon after ingestion.[35]

It has been shown to be helpful when administered within 1 hour of toxin ingestion. However, it is theoretically helpful in any patient who still has toxic contents within the stomach, and therefore its use should be considered up to 2 hours after ingestion. Care should be taken to avoid activated charcoal in cases where it may be contraindicated (i.e., gastric perforation) or where concern for aspiration is high.​[41]

Primary options

activated charcoal: consult specialist for guidance on dose

Plus – pressure and immobilisation of affected limb

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ACUTE
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all patients
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with blue-ringed octopus (tetrodotoxin) bite/cone snail (conotoxin) sting
Plus – 

pressure and immobilisation of affected limb

Treatment recommended for ALL patients in selected patient group

Should be performed using a pressure bandage or appropriate substitute material. The pressure bandage should be applied to the entirety of the affected limb, starting at the site of injection and moving proximally. Bandage pressure should be approximately 40 to 70 mmHg and 55 to 70 mmHg for the upper and lower limbs, respectively (similar to wrapping a sprained ankle or about as tight as one would apply an ankle brace).

The affected limb should remain immobile. Ambulation should be avoided if possible. If possible, a splint or sling should be applied to the affected limb to aid in immobilisation. In the field, clothing can remain on if removal of clothing will result in significant movement of the extremity.[42]​​

Consider – tetanus prophylaxis

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ACUTE
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all patients
|
with blue-ringed octopus (tetrodotoxin) bite/cone snail (conotoxin) sting
Consider – 

tetanus prophylaxis

Additional treatment recommended for SOME patients in selected patient group

Adults and children who have not received a tetanus booster within the past 5 years should receive tetanus prophylaxis for all marine toxin envenomation wounds.[40] Primary vaccination should be performed for children based on age and paediatric guidelines.

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Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

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