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Letter to the Editor

Letter to the Editor

Trichloroacetic Acid for Stingray Wounds?

Emergency Medicine News: May 2020 - Volume 42 - Issue 5 - p 23
doi: 10.1097/01.EEM.0000666372.73704.ab

    Editor:

    After reading Dr. Chris Schulze's article, I wondered if this treatment might work for puncture wounds from stingrays, which are extremely painful and also result from a protein-based toxin. (“A New Therapy for Brown Recluse Spider Bites,” EMN. 2020;42[3]:28; http://bit.ly/32J2qJx.)

    Might a dilute solution directed into the puncture be efficacious or too dangerous and damaging to the tissue?

    Claus Hecht, MD

    Orange County, CA

    Dr. Schulze responds: Thanks for your comments. As I suggested at the end of the article, TCA might be adapted to treat deeper puncture wounds, such as those from snakes. From what I researched online, TCA combines with available protein in a stoichiometric relationship, so a basic amount of TCA must be presented to offset the toxic enzymes.

    In the case of spiders and other insects, the total amount of enzymatic venom is quite low and is near the surface of the skin, so topical application seems to work pretty well. The amount and depth of toxic protein deposited by larger creatures can be expected to be greater and in a deeper location. A modification in delivery, perhaps with a fine catheter tip attached to a micropipette to deliver a small volume deeper into the wound, might do the job, and the surfactant effect would allow TCA to get into all the nooks and crannies. The chemical certainly will be corrosive to normal tissue, but the end effect may be preferable to the natural progression of disease from the venom.

    I don't have a good answer. Theoretically, it might work, but with some expected more severe side effects. Nonetheless, if I were out in the wild, far from medical care and antivenin, I might try the technique on myself! More research and consultation with experts who know more about the mechanics of envenomation and volumes delivered by larger creatures like stingrays are needed. It would make delivery easier if there were a puncture tract that could be followed.

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