Stone fish

Stonefish are found in warm coastal waters throughout the world and have been described as the world's most dangerous stinging fish. The two Australian species, S. trachynis and S. verrucosa (Reef stone fish), are found in northern Australian waters, from Brisbane to 600 km north of Perth. They are extremely well camouflaged and dig themselves into the surrounding sand or mud, making them almost impossible to see. Thirteen dorsal spines project from venom glands along their back. Venom is involuntarily expelled when the spine is pressed upon.

The sting from a stonefish is extremely painful and swelling rapidly develops. The severity of the symptoms is related to the depth of penetration of the spines and the number of spines involved. Systemic effects of the venom may include muscle weakness, paralysis and shock. Fatalities have been recorded in the Indo-Pacific region, but not in Australian waters. First aid consisting of bathing or immersing the stung area in hot water may be effective, but hospitalization for intravenous narcotic analgesia +/- local anaesthetic infiltration or regional block may be required. Definitive management consists of administration of stonefish antivenom, which is usually given intramuscularly.

Do not attempt to restrict the movement of the injected toxin. Most stonefish stings respond to bathing in hot (not scalding) water. Pain relief from severe stonefish stings may require a regional nerve block. All stonefish stings require medical attention as do most deep stings caused by other fish. Often foreign material and bacteria may be deposited quite deeply. A stonefish antivenom is available.

Indications for antivenom include:

• severe pain
• systemic symptoms or signs of envenomation (weakness, paralysis)
• multiple punctures indicating the discharge of several spines and thus injection of a larger amount of venom

Tetanus prophylaxis should be undertaken depending on the patient's immunization status. Severe stings may produce an area of tissue necrosis, particularly if antivenom administration is delayed. This may require surgical debridement or even skin grafting. Consideration should also be given to the presence of a foreign body (i.e. broken spines) within the wound, which should be X-rayed if possible.

Related Treatments

• Stinging fish, Treatment - including stone fish and stingray injuries

Related Venomous creatures

• Stinging fish

Journal Articles

• Murtha, E. F., 'Pharmacological Study of Poisons from Shellfish and Puffer Fish', Annals of the New York Academy of Sciences, vol. 90, no. 3, 1960, pp. 820-836. [ Details... ]