Vinegar may make certain jellyfish stings worse.+

[DocVikingo]

This not the 1st such warning on this topic (Are you out here DandyDon? ), but this the best published research to date.

“Diving Hyperb Med. 2014 Mar;44(1):30-4.

An in-vitro examination of the effect of vinegar on discharged nematocysts of Chironex fleckeri.

Welfare P1, Little M2, Pereira P3, Seymour J4.

Author information 1Emergency Department Cairns Base Hospital, PO Box 902, Cairns, Queensland 4870, Australia, Phone: +61 -(0)7-4226-8227, E-mail: pipwelfare@hotmail.com.2Emergency Department Cairns Base Hospital, Queensland Emergency Medical Research Foundation (QEMRF), Queensland Tropical Health Alliance, School of Public Health and Tropical Medicine, Centre for Biodiscovery and Molecular Development of Therapeutics, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Queensland, Australia.3Emergency Department Cairns Base Hospital, Queensland Emergency Medical Research Foundation (QEMRF), Australia.4Queensland Emergency Medical Research Foundation (QEMRF), Queensland Tropical Health Alliance, School of Public Health and Tropical Medicine, Centre for Biodiscovery and Molecular Development of Therapeutics, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Queensland, Australia.

Abstract

OBJECTIVE: To determine the effect acetic acid (vinegar) has on discharged nematocysts in a simulated sting from Chironex fleckeri.

METHOD: This research was performed in 2 parts: 1 C. fleckeri tentacles placed on amniotic membrane were electrically stimulated, and venom washings collected before and after application of vinegar. Lyophilised venom washings were run through a fast-performance protein liquid chromatography column to confirm the venom profile, with a quantitative measure of venom from each washing calculated using UNICORN™ software. 2 The toxicity of the washings was determined by application to human cardiomyocytes, with percentage of cell detachment providing a measure of cell mortality, and hence toxicity.

RESULTS: Part 1: There was a 69 ± 32% (F = 77, P < 0.001) increase in venom discharge after vinegar was applied compared to post electrical stimulation. Part 2: Venom collected after the administration of vinegar demonstrated the same toxicity as venom from electrically stimulated C. fleckeri tentacles and milked venom, causing cell mortality of 59 ± 13% at 10 µg ml&#8315;¹ compared to 57 ± 10% and 65 ± 7% respectively.

CONCLUSION: This in-vitro research suggests that vinegar promotes further discharge of venom from already discharged nematocysts. This raises concern that vinegar has the potential to do harm when used as first aid in C. fleckeri envenomation.”

Regards,

DocVikingo

 

[kwinter]

Doc - Isn't the proper protocol to scrape the site first to get rid of the ones that haven't discharged yet and only after that to apply the vinegar? Do you think this would make a difference?

 

[DandyDon]

This not the 1st such warning on this topic (Are you out here DandyDon?

Yes, sir! We had a long discussion about vinegar for stings almost six years ago, and a correction to my initial reaction to a DAN Diver's Alert article reflected in the title http://www.scubaboard.com/forums/diving-medicine/230816-vinegar-no-longer-included-my-dive-bag.html, you advised that vinegar was still a good treatment for fire coral and hydroids.

That DAN DA article did make an exception for the infamous Indo-Pacific box jelly Chironex fleckeri stating that vinegar was a good idea for that one if you lived long enough to get back on the boat, but now we see a contradiction to that advise? Excerpting from that thread...

The original research on the use of Vinegar was published in the Medical Journal of Australia and I think it would date back to the late seventies or early eighties. If I recall correctly people had been advocating the use of methylated spirits for the box jellyfish prior to that, but the reseach showed that this caused further firing of the nematocysts. However when they tried vinegar they found it inhibited the firing quite effectively. As a result of this research vinegar became the standard treatment for the box jelly and 'vinegar stations' where even placed on beaches in northern Queensland so people could access it in an emergency.

Hi Blue Devil,

Over the years, the Medical Journal of Australia has contained numerous articles on the treatment of jellyfish envenomations with acetic acid and similar compounds.

I believe that the original work you have mentioned may be: "Hartwick, R., Callanan, V. and Williamson, J., 'Disarming the Box-Jellyfish. Nematocyst Inhibition in Chironex Fleckeri', The Medical Journal of Australia, vol. 1, 1980, pp. 15-20."

Regards,

DocVikingo

I guess so few who get stung by the Indo-Pacific box jelly are going to survive long enough to try anything, but it'd help to know what works best. Wikipedia and Diver's Alert are still recommending vinegar.

Doc - Isn't the proper protocol to scrape the site first to get rid of the ones that haven't discharged yet and only after that to apply the vinegar? Do you think this would make a difference?

I think the reason for saving that step for later is "Nematocysts are mechanically activated. For this reason, medical texts and first aid manuals often recommend against rubbing or manipulation of the stung area as this may stimulate additional nematocyst firings."

Current suggestions for jellyfish stings include...
1-Flush with sea water, not fresh water;
2-Soak in hot water or hot shower around 113F/45C for 30 to 90 minutes ASAP;
3-Remove any remaining tentacles with tweezers;
4-Shave with shaving cream and razor or scrape with credit card;
5-Apply hydrocortisone cream or ointment;
6-Monitor for reaction or infection

 

[DocVikingo]

Doc - Isn't the proper protocol to scrape the site first to get rid of the ones that haven't discharged yet and only after that to apply the vinegar? Do you think this would make a difference?

Hi kwinter,

I believe that the last paragraph of Don Donaldo's post directly below yours provides the proper sequence of treatment steps per current protocols, with vinegar coming before scraping.

However, his prior paragraph regarding the reasoning behind this sequence, that rubbing or manipulation of the stung area may stimulate additional nematocyst firings, is called into question by this latest research since it now appears that both scraping & the application of vinegar may result in an increased venom load.

What is troubling about the use of vinegar in envenomations by this species (Chironex Fleckeri) is that it is good in that it denatures already discharged venom, but bad in that it may promote a substantial additional discharge of the venom remaining in already discharged nematocysts.

Before present treatment standards can be confidently revised, science will have to sort out which of these potential actions of vinegar provide the best chance of relief, and, more importantly, of survival from such stings.


Regards,


DocVikingo