How to treat jellyfish stings (hint: urine not recommended)

If you’ve been stung by a jellyfish on the beach, you know how painful and uncomfortable it can be. But how best to treat jellyfish stings has been debated for years.

Is it best to use hot water or an ice pack? How about pouring vinegar or rubbing in sand? Then there’s the common myth about leg urination that health professionals have debunked many times, but seems to be resurfacing nonetheless.

We’ve looked at the evidence for popular treatments and just published our analysis in a Cochrane review. We found that.

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Why do jellyfish stings hurt so much?

Jellyfish are common in coastal regions around the world.

Sea spike warning sign
Be careful, it’s teeming with jellyfish.

They have tentacles covered with tiny stinging cells called nematocysts. When these cells touch your skin, they release toxins that can cause burning, redness, swelling, and sometimes more serious reactions like heart problems.

Fortunately, most jellyfish stings are not life-threatening. Symptoms vary by species. And the best treatment for one species isn’t always the best for another.

Knowing which treatments work and which don’t can help ease your symptoms and prevent complications.

Read more: Want to avoid a blue bottle bite? So you can predict which beach they will land on

What we have done

We found nine studies treating two types of jellyfish:

  • blue bottles or Portuguese man of war (Physalia)

  • box jellyfish (Cubozoa), which are considered the most dangerous jellyfish. Some box jellyfish can cause Irukandji syndrome (a condition that can cause severe pain, heart problems and, in rare cases, death).

In these trials, involving 574 people, various treatments including vinegar, hot water, ice packs, isopropyl alcohol, denatured alcohol, ammonia and sodium bicarbonate were tested.

The studies also looked at Adolph’s Meat Tenderizer (a powder thought to break down proteins) and Sting Aid (an over-the-counter remedy thought to relieve pain after various stings).

Read more: Welcome to Australia, a land full of creatures out to kill you…maybe

So what works?

Regardless of the jellyfish species, it makes sense to first remove any visible tentacles with tweezers or a gloved hand. What to do next depends on the species.

Try heat on squirt bottles

The data from our included studies provide low-certainty evidence for soaking the affected area in approximately 45°C water to relieve pain. This is believed to denature the venom protein. On the beach you can apply a heat pack or take a hot shower.

There wasn’t enough evidence to show whether other treatments, such as ice packs, were effective for bluebottle bites.

Bluebottle on sandy beach
Stung by a slug? Try warm water or a heat pack.

For box jellyfish, try vinegar

For box jellyfish stings, the evidence was more limited. Our review found insufficient evidence to support current recommendations for using vinegar to inactivate the nematocysts.

Still, it makes sense to try vinegar. That’s because evidence unconsidered as part of our investigation shows that vinegar inactivates nematocysts when tested in the lab.

When to see a doctor

Most symptoms can be treated at the beach or at home. However, always see a doctor if you or the person you are caring for have any of the following symptoms:

  • difficulty breathing

  • chest pain

  • nausea

  • Vomit

  • weakness, or

  • Sleepiness.

Such serious symptoms may require hospital monitoring and treatment. If the person stops breathing or has a heart attack, they will need immediate life support.

Read more: During cardiac arrest, time is everything. Community responders can save lives

What not to do

Don’t rub or scrape the area with sand or a towel, as this could cause more nematocysts to release their venom.

As for the treatments, our review found that some of them may be harmful or ineffective and should therefore be avoided.

These included ammonia, denatured alcohol, and fresh water, as they can cause burns on the skin or cause more venom to be released from nematocysts.

Avoid pressure immobilization bandages (wrapping a bandage tightly around the limb) as this can also lead to greater venom release from nematocysts.

We’ve found that vinegar, sodium bicarbonate, Sting Aid, or meat tenderizers have no proven benefit and can cause irritation or infection.

Perhaps unsurprisingly, there have been no published studies looking at the effectiveness of urine as a treatment, and as such it is not recommended.

Prevention is best

Remember: prevention is better than cure. Keep an eye on lifeguard safety instructions, monitor the water for jellyfish, and wear protective clothing to avoid stings if possible.

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