How to Treat a Lionfish Sting

Lionfish look delicate as they use their fan-like fins to gently move through the ocean, but don't be fooled by this flamboyant fish. They are an invasive, meat-eating species that reproduces quickly. A female lionfish can release up to 2 million eggs a year. While they are native to the South Pacific and Indian Oceans, they have spread rapidly into the North Atlantic, including the Gulf of Mexico and Caribbean Sea. They are popular aquarium fish, and it is thought that owners releasing their lionfish into the wild have facilitated their spread to non-native waters. Lionfish have big appetites and have no natural predators in Atlantic waters. When they arrive at a coral reef, they can eat so much that they reduce the local fish population by as much as 70%. The National Oceanic and Atmospheric Administration has launched a campaign urging people to eat lionfish to help reduce their numbers. However, the Food and Drug Administration warns that lionfish can contain a toxin known as ciguatera. Ciguatera toxin is heat stable and cooking does not remove the toxin from the meat. There is no specific prevention when it comes to ciguatera exposure; however, eating fish smaller than about 4-6 pounds reduces the risk. The average lionfish weighs approximately 1-2 pounds. Properly prepared lionfish is supposed to be pretty tasty!

The majority of calls made to Poison Control about lionfish involve stings. Although lionfish stings are very painful, most can be managed at home if pain is controlled and tetanus immunization is up to date. Symptoms following lionfish stings develop within minutes to a few hours and can include swelling, tenderness, warm skin directly surrounding the sting site, redness, sweating, muscle weakness, and a tingling sensation. A lionfish sting involving multiple spines increases the risk of infection and body-wide symptoms such as changes in heart rate, abdominal pain, sweating, and fainting. Deaths from lionfish stings are rare. Symptoms can last anywhere from 8 hours to 30 days depending on the severity of the sting.

If you are stung by a lionfish, here are some first-aid steps:

• Wearing gloves and using tweezers, carefully remove spines from the wound, trying not to squeeze the venom glands.
• Wash the area with soap and water.
• Soak the affected limb in water hot enough to tolerate but not to burn, or take a hot shower for 10–20 minutes. An adult should test the water to make sure it is not scalding hot for children.
• Use over-the-counter medication to treat pain.
• Call your doctor or pharmacist to make sure your tetanus immunization is up to date.
• An x-ray might be needed to ensure that there are no broken spines left in the sting site.

Visit an urgent care center or emergency room if you experience any of the following:

• severe muscle aches or cramps.
• severe or persistent pain at sting site.
• feeling faint.
• evidence of infection such as fever, expanding redness, swelling, or pus.
• paralysis.
• spines still visible in the wound after attempts to remove them.

If you suspect someone has been stung by a lionfish and is experiencing symptoms, check the webPOISONCONTROL^® online tool for guidance or call Poison Control at 1-800-222-1222.

Lindsy Liu, PharmD
Certified Specialist in Poison Information