Jellyfish sting – evidence does not support peeing on it

October 3, 2012, 1:19 am

Physalia physalis


Evidence-Based Treatment of Jellyfish Stings in North America and Hawaii. Ward NT et al. Ann Emerg Med 2012 Oct;60:399-414.


Determining evidence-based recommendations for treating jellyfish stings is extraordinarily difficult. (Translation = impossible)  Anyone who attempts to analyze the literature on this topic has to contend with the problems of multiple different species, different treatment protocols, and different experimental endpoints,  as well as publication bias.

Therefore, the authors of this massive literature review deserve credit for tackling what may be a thankless task. They reviewed medical literature in English dealing with jellyfish stings in North America and Hawaii, identifying 19 relevant articles.


They suggest that treatment of these stings should pursue two distinct goals: 1)  preventing venom-induced pain and tissue damage, and 2) preventing further activation of nematocysts.

They conclude:

. . . current treatments for jellyfish envenomations demonstrate variable response, with conflicting results between studies and species. A treatment beneficial for one species may in fact worsen an envenomation from another. This contributes to considerable confusion about what treatment is best for stings whether the species is known or unknown.

The authors disagree with the American Heart Association recommendations that vinegar or baking soda be applied, pointing out that many studies suggest that vinegar exacerbates pain and nematocyst discharge in species other than Physalis (Man O’ War). Instead they recommend application of hot water and topical lidocaine, unless the sting appears to be caused by Physalis. They realize that these modalities may not be readily available in the field, and that the exact jellyfish responsible to a specific sting may not be known.


They do not specifically discuss a frequently discussed intervention: urinating on the body area affected by the sting. And that, of course, brings to mind this classic segment from the TV sitcom Friends:


If the above video does not play, you can see it here.

Related posts:

Irukandji syndrome: a superb review article

Is that a jellyfish on your leg, or are you just glad to see me? Priapism and Irukandji syndrome

Irukandji syndrome case series from Australia’s tropical northern territory





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