That is the Question – A few years back I remember watching a TV sitcom in which a few friends administered a rumoured medication to another friend who had been stung by a sea creature.  This magical antidote was—you guessed it—urine.  Yuck. I can think of many other remedies that are more effective.  In the show, the miraculous treatment worked to ease the pain.  Unfortunately, in the real world, treating a box jellyfish sting by urinating on it may actually intensify the pain rather than provide the intended relief.  That’s because urine can provoke the box jellyfish’s stingers into releasing more venom. The urine cure is, indeed, fiction.  Let’s take a closer look at why this is so.

Box jellyfish in this area are water-dwelling invertebrates belonging to the class Scyphoza.  The species of box jellyfish most (in)famous amongst humans in this area is named for its cubed-shaped medusa;  Cubomedusae, while sometimes simply called the “box jellyfish,” is only one species of the category, which actually contains about 19 different species. Box jellyfish are best known for their extremely powerful sting and the resulting pain.  Depending on the species, size, geographic location, time of year and other factors, the symptoms associated with these stings can range in severity from mild burning and skin redness to excruciating pain and severe blistering with generalized illness (nausea, vomiting, shortness of breath, muscle spasms and low blood pressure).

Some of the box jellyfish’s skin cells are stinging cells, or cnidocytes.  These specialized cells have organelles called nematocysts that contain venom.  These tentacles can be so long that swimmers might not see the box jellyfish that stings them, but they will certainly feel it.  The pain is usually instant and quite noticeable. Once stung, angry, red, whip-like lash marks and welts appear on the skin.  The pain radiates from the sting site and starts to itch, burn and throb.  Scratching will make the pain worse because rubbing activates the nematocysts, which release more venom.

Box jellyfish stings are painful, but they are rarely life-threatening, at least in North America and the Caribbean West Indies.  The pain will not last longer than a day depending on what kind of box jellyfish stings you.  Those 24 hours, though, could be uncomfortable in the absence of treatment.

Most sources recommend washing the area with salt water, which will deactivate whatever pesky nematocysts are still hanging on.  A freshwater rinse will have the opposite effect.  Any change to the balance of solutes, such as the concentration of salts inside and outside of the cnidocyte, sets off stinging.  Adding fresh water to the sting site dilutes the salts outside the cell, unbalancing the solutes. In reaction to this change, the nematocysts in the cells release more venom—thereby causing more pain.

But what about urine? It contains salts.  The concentration of salts and other compounds people have in their urine varies from person to person and hour to hour.  Someone drinking lots of fluids will have urine that is too dilute, which will be similar to fresh water.  This can cause a discharge of box jellyfish nematocysts. And let’s not forget possible infections caused by bacteria.

Other liquids and compounds, however, can help. Most stings in the North American and Caribbean waters can be relieved by vinegar.  Why?  Vinegar is an acetic acid.  This type of acid deactivates the nasty nematocysts. It would be best to place vinegar in a spray bottle and saturate the area with spray for no less than 10 minutes.  You can also use the stream setting on the spray bottle to push the tentacles away with force.  The combination of vinegar and baby powder (also known as talcum powder) provides a powerful one-two punch.  On its own, baby powder surrounds the nematocysts and dries them up, stops the releasing of stingers and enables you to scrape them off fast.  But overall, vinegar is the key.

Using diluted ammonia may work, but the afflicted person can suffer severe eye damage or respiratory complications should this solution get into his or her eyes or air passage.  Not a good thing. Meat tenderizers do just that—tenderize meat, resulting in severe damage to skin if left on for any period of time.  

For pain, an oral analgesic should provide relief for those suffering from North American and Caribbean box jellyfish stings.  If minor allergic reactions occur, a dose, as directed, of an antihistamine like Benadryl should do the trick.  A trip to a medical facility should also be on your list of things to do.  If breathing difficulties become apparent, “anaphylaxic shock” may set in.  This condition requires the administration of epinephrine (via EpiPen®) and immediate medical attention.  

An overriding principle in the treatment of any injury is:  Do no further harm.  Therefore, avoid applying unproven and possibly harmful substances to stings, especially rum.

Ultimately, vinegar, baby powder and medical attention—not urine—are the best treatments for a box jellyfish sting here in the BVI.  Since not all box jellyfish are identical, it is extremely helpful to know ahead of time what types of species are relevant to your area of the world.

by Mark Wollner