Stonefish venom is toxic and contains the chemical verrucotoxin.

Venomous stonefish and related sea animals live in tropical waters, including off the warm coasts of the United States. They are also considered prized aquarium fish, and are found worldwide in aquariums.

A stonefish sting causes intense pain and swelling at the site of the sting. Swelling can spread to an entire arm or leg within minutes.

Below are symptoms of a stonefish sting in different parts of the body.

AIRWAYS AND LUNGS

• Difficulty breathing

HEART AND BLOOD

• No heartbeat
• Irregular heartbeat
• Low blood pressure
• Collapse (shock)

SKIN

• Bleeding.
• Severe pain at the site of the sting. Pain can spread quickly into the entire limb.
• Lighter color of the area around the sting.
• Change to the color of the area as oxygen decreases.

STOMACH AND INTESTINES

• Abdominal pain
• Diarrhea
• Nausea and vomiting

NERVOUS SYSTEM

• Anxiety
• Delirium (agitation and confusion)
• Fainting
• Fever (from infection)
• Headache
• Muscle twitching
• Numbness and tingling, spreading out from the site of the sting
• Paralysis
• Seizures
• Tremors (shaking)

Seek medical help right away. Contact your local emergency services.

For superficial stings to an arm or leg, you can take the following first aid steps while waiting for medical help.

• Immediately get out of the water and into a safe environment.
• Control any bleeding that occurs by applying direct pressure to the wound with a clean cloth or bandage.
• Next soak the wound with hot water. The water should be around 100°F to 113°F (40°C to 45°C) or as hot as can be comfortably tolerated. Soak for 30 to 90 minutes, periodically checking to make sure the water is still warm. Soaking in hot water helps to inactivate the venom and relieve pain. After soaking, gently wash the wound with mild soap and clean water to remove any dirt, debris, or venom that may be present.
• Apply an over-the-counter antibiotic ointment unless you have an allergy to this type of medication.
• Then cover the wound using a sterile bandage or non-stick dressing and tape.

Have this information ready:

• Person's age, weight, and condition
• Type of fish, if known
• Time of the sting
• Location of the sting

Your local poison control center can be reached directly by calling the national toll-free Poison Help hotline (1-800-222-1222) from anywhere in the United States. This national hotline will let you talk to experts in poisoning. They will give you further instructions.

This is a free and confidential service. All local poison control centers in the United States use this national number. You should call if you have any questions about poisoning or poison prevention. It does NOT need to be an emergency. You can call for any reason, 24 hours a day, 7 days a week.

The health care provider will measure and monitor the person's vital signs, including temperature, pulse, breathing rate, and blood pressure. The wound will be soaked in a cleaning solution and any remaining debris will be removed. Symptoms will be treated as appropriate. Some or all of the following procedures may be performed:

• Blood and urine tests
• Breathing support, including oxygen, tube through the mouth into the throat, and breathing machine (ventilator)
• ECG (electrocardiogram, or heart tracing)
• Fluids through a vein (by IV)
• Medicine, called antiserum, to reverse the effect of the venom
• Medicine to treat symptoms
• X-rays

Recovery usually takes about 24 to 48 hours. Outcome often depends on how much venom entered the body, the location of the sting, and how soon the person received treatment. Numbness or tingling may last for several weeks after the sting. Skin breakdown is sometimes severe enough to require surgery.

A puncture to the person's chest or abdomen may lead to death.

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Elston DM. Bites and stings. In: Bolognia JL, Schaffer JV, Cerroni L, eds. Dermatology. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 85.

Auerbach PS, DiTullio AE. Envenomation by aquatic vertebrates. In: Auerbach PS, Cushing TA, Harris NS. eds. Auerbach's Wilderness Medicine. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 75.

Warrell DA. Animals hazardous to humans: venomous bites and stings and envenoming. In: Ryan ET, Hill DR, Solomon T, Aronson NE, Endy TP, eds. Hunter's Tropical Medicine and Emerging Infectious Diseases. 10th ed. Philadelphia, PA: Elsevier; 2020:chap 137.

Updated by: Jesse Borke, MD, CPE, FAAEM, FACEP, Attending Physician at Kaiser Permanente, Orange County, CA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.