Fish stings and other marine envenomations

West Virginia, it would seem, is an unlikely place for physicians to encounter patients with poisonous marine envenomations. To the contrary, West Virginias who vacation at the beach may be envenomated and require further evaluation and treatment when they return home. Likewise, certain aquarium pets or even freshwater fish may envenomate those who have contact with them. Such underwater sea creatures can cause local and systemic toxic or allergic reactions which potentially can be serious. This article describes these possible toxic encounters as well as first aid and medical management.