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Mollusk Stings

By

Robert A. Barish

, MD, MBA, University of Illinois at Chicago;


Thomas Arnold

, MD, Department of Emergency Medicine, LSU Health Sciences Center Shreveport

Last full review/revision Apr 2020
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Mollusks include cones (including cone snails), cephalopods (including octopi and squids), and bivalves.

Conus californicus

Conus californicus is the only known dangerous cone in North American waters. Its sting causes localized pain, swelling, redness, and numbness that rarely progresses to paralysis or shock.

Treatment is largely supportive. Local measures seem to be of little value, and reports that local injection of epinephrine and neostigmine are helpful are unproved. Severe Conus stings may require mechanical ventilation Overview of Mechanical Ventilation Mechanical ventilation can be Noninvasive, involving various types of face masks Invasive, involving endotracheal intubation Selection and use of appropriate techniques require an understanding... read more and measures to reverse shock.

Cone snails

Cone snails are a rare cause of marine envenomation among divers and shell collectors in the Indian and Pacific Oceans. When the snail is aggressively handled (eg, during shell cleaning, when placed in a pocket), it injects its venom through a harpoon-like tooth. Multiple neurotoxins in the venom block ion channels and neurotransmitter receptors, resulting in paralysis, which is usually reversible but has resulted in some deaths.

Treatment is supportive and may include local pressure immobilization (eg, by wrapping wide crepe or other fabric bandages around the limb), immersion in hot water, and tetanus prophylaxis (see table Tetanus Prophylaxis in Routine Wound Management Tetanus Prophylaxis in Routine Wound Management Tetanus is acute poisoning from a neurotoxin produced by Clostridium tetani. Symptoms are intermittent tonic spasms of voluntary muscles. Spasm of the masseters accounts for the name lockjaw... read more Tetanus Prophylaxis in Routine Wound Management ). Severe cases may require respiratory support.

Octopi

The bites of North American octopi are rarely serious.

Bites from the blue-ringed octopus, most common in Australian waters, cause tetrodotoxin Tetrodotoxin poisoning Fish poisoning and shellfish poisoning commonly cause gastrointestinal, neurologic, or histamine-mediated manifestations. (See also General Principles of Poisoning.) Ciguatera poisoning may... read more envenomation, with local anesthesia, neuromuscular paralysis, and respiratory failure; treatment is supportive.

Squid

The large (up to 1.5 m), aggressive Humboldt squid is present off the west coast of the Americas; it has reportedly bitten fishermen and divers. Other squid species are of less concern.

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Test your knowledge
Snakebites
More than 60,000 bites and stings are reported to poison centers in the US each year, about 45,000 of which are snakebites (of which 7,000 to 8,000 are venomous and cause about 5 deaths). Which of the following types of snakes accounts for the majority of these bites and almost all deaths? 
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