Is magnesium beneficial in treating Irukandji jellyfish stings?
Randomized trial of magnesium in the treatment of Irukandji syndrome. McCullagh N et al. Emerg Med Australas 2012;24:560-565.
Irukandji Syndrome is caused by stings from several jellyfish, primarily Carukia barnesi. Important symptoms include pain and cramping in trunk and extremities. In addition, catecholamine surge causes tachycardia and hypertension. Two deaths have been reported from intracranial hemorrhage associated with Irukandji Syndrome.
Because magnesium has been shown to decrease catecholamine release and receptor responsiveness, and based on anecdotal evidence from a handful of cases, magnesium has become in some venues recommended treatment of Irukandji Syndrome.
The primary goal of this randomized, double blind study from Cairns, Australia was to determine the effect of adding magnesium on total analgesic requirement in patients presenting with Irukandji Syndrome.Patients received standard treatment alone, with fentanyl bolus plus additional doses via a patient-contolled pump, with standard treatment plus magnesium. There were 17 patients in the placebo group and 22 in the magnesium group. The authors found no difference between the placebo and magnesium groups regarding mean total opiate dose (53 and 50 morphine equivalent doses, respectively) or mean length of stay (19 and 20.7 h).
. . .did not demonstrate a benefit in the use of magnesium in the treatment of Irukandji syndrome. As such the current use of magnesium needs to be reconsidered until there is good evidence to support its use.
This study has many limitations, which the authors discuss in detail. The number of patients enrolled is extremely small. There is no evidence that the dose of magnesium used was optimal, or that the results would apply to other geographic areas where the variety of jellyfish causing Irukandji Syndrome may be different.Baseline patient characteristics — most importantly pain scores — were not measured or reported. To their credit, the authors discuss the limitations in detail. Unfortunately, because of the difficulties involved in doing these kind of studies, we probably will never know whether or not magnesium truly helps in these cases.
Dr. Jamie Seymour, a co-author of this study, is featured in the video above. and also in the one below. Both are about Irukandji Syndrome, and both are well worth watching.
A great discussion of Jack Barnes and his discovery of what caused Irukandi syndrome was posted by Chris Nickson at Life in the Fast Lane. To read it, click here.