The major causes of penetrating marine envenoming or injuries are:
1. Venomous fish: stone fish, catfish, scorpion fish, weever fish
2. Sting rays
3. Echinoderms: sea urchins

There are a huge variety of different venomous fish and stingrays throughout the world which are summarised in tables 1 to 3.

Table 1: List of important groups of venomous fish that have been implicated in envenomation.

Group
Distribution
Examples
Stonefish (Synanceia spp.)
Tropical and warm temperate oceans, including central Pacific, Indo-Pacific and east to the African coast
Australian estuarine stonefish (S. trachynis), the Indian stonefish (S. horrida) and the reef stonefish (S. verrucosa)
Scorpionfish (Scorpaenidae)
Worldwide mainly in tropical and temperate oceans
Lionfish (Pterois volitans), soldierfish or cobbler (Gymnapistes marmoratus), sculpin (Scorpaena guttata), red rock cod(S. ergastulorum), bullrout (Notesthes robusta), Fortesque (Centropogon australis)
Weever fish (Trachinidae)
Mediterranean, European coastal areas, Black Sea, Pacific Ocean of the coast of Chile
Greater weever fish (Trachinus draco) and the lesser weever fish (Echiichtis vipera)
Scats (Scatophagidae)
Indo-Pacific Ocean
Silver scat, striped butterfish or spadefish (Selenotoca multifasciata)
Rabbitfish or happy moments (Siganidae)
Tropical Indo-Pacific region
Siganus spp.
Enoplosidae
Australia (temperate waters)
Old wife (Enoplosus armatus)

Table 2: List of the families of catfish that have been implicated in envenomation.

Family
Distribution
Examples
Ariidae
Worldwide
Arius spp.
Bagridae
Asia, Africa, Japan
Pseudobagrus, Liobagrus reini
Clariidae
Indo-Pacific and India
Clarias batrachus
Doradidae
Fresh waters of South America
Pterodoras granulosus, Centrochir crocodili
Heteropheustidae
India
Heteropneustes fossilis
Ictaluridae
America,
Ictalurus and Noturus
Pimelodidae
South America to Mexico
Pimelodus clarias
Plotosidae
Indo-Pacific region including Australia
Plotosus lineatus, Cnidoglanis megastoma, Tandanus bostocki
Siluridae
Africa and Asia



Table 3: Important families of stingrays and their distributions

Family
Common Name
Examples
Distribution
Urolophidae
Round stingrays or stingarees
Urolophus
Worldwide
Dasyatidae
Stingrays or whip rays
Dasyatis, Taeniura, Urogymnus
Worldwide
Potamotrygonidae
River rays
Potamotrygon
South America
Gymnuridae
Butterfly rays
Gymnura
America
Myliobatidae
Bat or devil rays
Aetobatus narinari, Myliobati
Worldwide
Rhinopteridae
Cow-nosed rays
Rhinoptera
Europe and America

Treatment

The treatment of marine injuries is similar with minor modifications depending on the size of the wound and the presence of broken off spines.

First Aid
  • Wound site: wash with water
  • Bleeding: local pressure
  • Pain: immerse in hot water (45ÂșC) for a maximum duration of 90 minutes
Hospital Treatment
  • local irrigation of the wound and removal of foreign material/spines
  • radiography or ultrasound to identify retained spines or foreign bodies
  • oral or titrated parenteral analgesia and/or local or regional anaesthesia; the latter may assist with exploration of the wound
  • stonefish antivenom is available for stonefish stings with severe pain or systemic effects
  • surgical consultation is required for deep injuries, involvement of joints or bones or retained foreign material
  • thoracic or abdominal stingray injuries should be treated as major trauma with appropriate resuscitation and surgical intervention
  • prophylactic antibiotics should be considered for large wounds with foreign material or delayed presentation
  • all penetrating marine injuries must be reviewed every 24 to 48 hours for the first week