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  3. Clinical entry: Octopuses

Clinic: Octopuses

Examine for venom effects

Local Effects

  • Pain
  • reddness
  • swelling

Neurological effects

  • Descending flaccid paralysis (rarely progresses to involve bulbar and respiratory muscles):
    • Ptosis (not to be mixed up with tiredness / drowsiness; test: lid retraction with upward gaze).
    • Double vision (external ophthalmoplegia)
    • Difficulties to swallow (dysphagia) (bulbar paralysis) > inhalation of vomitus!
    • Difficulties to lift the head when lying on the back (‘broken neck syndrome’)
    • Cyanosis, shallow breathing, respiratory arrest (respiratory paralysis); respiratory arrest may be precipitated by obstruction of the upper airway by the paralysed tongue or inhaled vomitus. 
    • Weakness or loss of voluntary movement; movements of digits may still be possible, allowing the patient to communicate.
    • Loss of consciousness and generalized convulsions caused by hypoxaemia in patients who have respiratory paralysis.  

Species-specific envenoming pattern

The assessment of the envenoming pattern is based on the data from publication in which the identification of the ostopus is clearly specified and in accordance with accepted criteria.

  

Local effects

 Neurological effects 

Hapalochlaena sp.

    

Local effects

Bite painless. Local redness (Flecker and Cotton 1955, Hopkins 1964, Sutherland 1983, Walker 1983).

Neurological effects

Symptoms of envenoming commence within minutes after the bite and progress rapidly. Nausea, vomiting, paraesthesias of the facial region. Rapidly progressive paralysis with very early involvement of the respiratory musculature. In particular the phrenic supply to the diaphragm is affected. Respiratory insufficiency and respiratory failure (Flecker and Cotton 1955, Hopkins 1964, Sutherland 1983, Lane and Sutherland 1967, Walker 1983).

Morbidity and case fatality rate

Of 11 cases reported between 1950 and 1983, 5 recovered within 24 h, 4 required days to weeks to recover and 2 died (see below) (Flecker and Cotton 1955, Hopkins 1964, Sutherland 1983, Lane and Sutherland 1967, Walker 1983).
1/1 (Flecker and Cotton 1955).
1/1 (Lane and Sutherland 1967).

Clinical management

First Aid

Compression-immobilisation method (Sutherland 1983.

Seek medical assistance immediately.

Local treatment

Bite site

Tetanus prophylaxis
Standard wound care
WHO (2010) 

Systemic supportive treatment

A general understanding of emergency medicine is required, or can be found in emergency medicine guidelines, e.g. ABCDE approach, WHO-ICRC Basic Emergency Care.

Follow ABCDE approach

WHO-ICRC Basic Emergency Care: approach to the acutely ill and injured

Obey Hapalochlaena sp. - specific features

see 'Species-specific envenoming pattern' above.

Key issues: 

Respiratory failure

Lifesaving in Octopus envenoming:

Airway management
Breathing: Oxygen ⇨ assisted ventilation ⇨ mechanical ventilation

Endotracheal intubation and artificial respiration are the most important measures in the case of respiratory insufficiency.

Specific treatment (antivenoms)

No antivenom available.

References 

  • WHO-ICRC Basic Emergency Care: approach to the acutely ill and injured https://www.who.int/publications-detail-redirect/basic-emergency-care-approach-to-the-acutely-ill-and-injured  https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/bec-quick-cards/becp-edu29-pdf-en-finl.pdf?sfvrsn=2532d61b_2 
  • WHO ABCDE Approach https://cdn.who.int/media/docs/default-source/integrated-health-services-(ihs)/csy/bec-quick-cards/becp-edu29-pdf-en-finl.pdf?sfvrsn=2532d61b_2
  • WHO (2010) Wound and lymphoedema management. WHO/HTM/NTD/GBUI/20101 I. 2010. https://www.who.int/publications/i/item/9789241599139 

Species-specific evidence

Hapalochlaena lunulata

Australia 

  • Flecker and Cotton (1955)
     1 patient; identification: morphological. 
  • Lane and Sutherland (1967)
    1 patient; identification: morphological.

Hapalochlaena maculosa

  • Hopkins (1964)
    1 patient; identification: morphological. 
  • Sutherland (1983) 
    Summary of cases from the literature and 1 personal communication. Identification: morphological and/or clinical course. 
  • Walker (1983)
    2 patients; identification: morphological; clinical course.

Reviews

  • Sutherland (1983) 

  • Sutherland and Lane (1969)