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Background: The Persian Gulf is one of the best places to find tropical venomous animals. The second cause of marine injuries in the Persian Gulf region is stonefish, it seems that the medical practitioners in this region are not familiar with the medical management of stonefish envenomationon. Materials and methods: A total of 16 patients with stonefish envenomation were serially examined in emergency rooms of academic hospitals of Boushehr port and Delvar clinic. In these patients local and systemic manifestations, first aid management and therapeutic interventions were evaluated. Results: The most common sites of injury were lower extremity (14 cases) and upper extremities (2 cases). The most common prescribing medication for relief of pain was injection of local lidocaine. The second and third most common prescribed drugs were parenteral antihistamines and corticosteroids, respectively. Hot water was not used in any of patients. Only in 2 cases antibiotic were given, whereas tetabolin was not prescribed in any of them. Conclusion: Although the most effective pain relieving intervention for stonefish envenomation, it was not used in injured patients in the current study. Likewise, tetabolin was not used. The medical practitioners should be encouraged to use immersion of the injured site in hot water, injection of local lidocaine without adrenalin, tetabolin injection and prophylactic broad spectrum antibiotics in stonefish envenomation.

Abstract The members of Scorpaenidae family, including stonefish (genus Synanceja) are among the most dangerous and venomous fishes in the word that inhibit in the tropical shallow waters. The toxinology of the venom of stonefish (genus Synanceja) showed that it is a mixture of proteins, containing several enzymes like hyaluronidase. The crude venom can produce cytolytic, hemolytic, neurotoxic and hypotensive effects in vivo. Immediate increasing intensive pain, local ischemia followed by cyanosis, edema and swelling are the local clinical presentations. Systemic manifestations are not uncommon. Hot water immersion of the injured limb, a local anesthetic agent without adrenaline, infiltrated into and around the wound, debridement of the necrotic tissue and the prescription of prophylactic antibiotic are the main therapeutic measures. The administration of antivenom may be considered.