Blue-Ringed Octopus

Blue-Ringed Octopus – famous from the James Bond Film Octopussy – the BRO contains tetrodotoxin which is a potent sodium channel blocking neurotoxin resulting in rapid paralysis. Bites usually occur if you are hanging around Bond villains or you pick these up and play with them, the venom comes from a beak under the body of the octopus and not the tentacles. Scarily you will will become paralysed soon after the bite but will be fully aware like a locked in syndrome.


Potential life threats include:

  • Descending flaccid paralysis with respiratory failure – if present will require intubation and ventilation
  • Hypotension
Risk Assessment

Typical symptoms include:

  • The bite is usually not painful and local symptoms are minimal
  • Systemic envenoming is characterised by a rapidly progressive symmetrical descending flaccid paralysis, which usually presents within minutes
  • Early signs of paralysis include ptosis, blurred vision, diplopia and difficulty swallowing. If left untreated, generalised paralysis respiratory failure and a hypoxic arrest will ensue. Paralysis resolves after 24 hours.
Supportive Care
  • Apply a pressure bandage prehospital
  • In the field basic life support maybe required including mouth to mouth ventilation
  • Intubation and ventilation for any signs of paralysis should be strongly considered.
  • Spirometry and peak flows can be used to detect early signs of impending respiratory failure.
Differential Diagnosis:
  • Envenoming by the box jellyfish can cause collapse and sudden death but it is associated with immediate pain and dermal markings are characteristic in these cases.
  • Puffer fish also contain tetrodotoxin but requires a history of ingestion to lead to a flaccid paralysis
  • None available
  • Patients without evidence of paralysis at six hours can be discharged in daylight hours.
  • Anyone who has paralysis will need an admission on ICU until symptoms resolve.

References and Additional Resources:

Additional Resources:


  • Cavazioni E, Lister B, Sargent P, Schibler A. Blue-ringed octopus (Hapalochlaena sp.) envenomation of a 4-year-old boy: a case report. Clinical Toxicology 2008; 46:760-761
  • Sutherland SK, Lane WR. Toxins and mode of envenomation of the common ringed or blue-banded octopus. Medical Journal of Australia 1969; 1:893-898
  • Sutherland SK, Tibballs J. Australian animal toxins: the creatures, their toxins and care of the poisoned patient. South Melbourne: Oxford University Press; 2001.
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Dr Neil Long BMBS FACEM FRCEM FRCPC. Emergency Physician at Kelowna hospital, British Columbia. Loves the misery of alpine climbing and working in austere environments (namely tertiary trauma centres). Supporter of FOAMed, lifelong education and trying to find that elusive peak performance.

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