It is unknown how many other deaths from Irukandji syndrome have been wrongly attributed to other causes. Pathophysiology
The exact mechanism of action of the venom is unknown, but catecholamine excess may be an underlying mechanism in severe cases. Animal studies appear to confirm a relationship between envenoming and an increase in circulating noradrenaline and adrenaline. Treatment
Similar to other box jellyfish stings, first aid consists of flushing the area with vinegar to neutralize the tentacle stinging apparatus. As no antivenom is available, treatment is largely supportive, with analgesia being the mainstay of management. Nitroglycerin, a common drug used for cardiac conditions, is utilised by medical personnel to minimise the risk of pulmonary edema and to reduce hypertension. Antihistamines may be of benefit for pain relief, but most cases require intravenous opioid analgesia. Fentanyl or morphine are usually chosen. Pethidine (meperidine, brand name Demerol in the US) should be avoided, as large doses are often required for pain relief and in this situation significant adverse effects from the pethidine metabolite norpethidine may occur.Magnesium sulfate (Epsom Salts) has been proposed as a treatment for Irukandji syndrome after being apparently successfully used in one case. Early evidence suggested a benefit; however, according to a later report, a series of three patients failed to show any improvement with magnesium; the author emphasized the experimental status of this treatment.
Estropipate, also known as piperazine estrone sulfate and sold under the brand names Harmogen, Improvera, Ogen, Ortho-Est, and Sulestrex among others, is an estrogen medication which is used mainly in menopausal hormone therapy in the treatment of menopausal symptoms. It is a salt of estrone sulfate and piperazine, and is transformed into estrone and estradiol in the body. It is taken by mouth. Medical uses
Estropipate is used to:
Alleviate symptoms of menopause as menopausal hormone therapy
Treat some types of infertility
Treat some conditions leading to underdevelopment of female sexual characteristics
Treat vaginal atrophy
Treat some types of breast cancer (particularly in men and postmenopausal women)
Treat prostate cancer
Prevent osteoporosis

Available forms
Estropipate is available in the form of 0.75, 1.5, 3, and 6 mg oral tablets. Pharmacology
Pharmacodynamics
Estropipate is a prodrug of estrone and estradiol. Hence, it is an estrogen, or an agonist of the estrogen receptors. Pharmacokinetics
Estropipate is hydrolyzed into estrone in the body. Estrone can then be transformed into estradiol by 17β-hydroxysteroid dehydrogenase. Chemistry
History
Estropipate was introduced for medical use by Abbott in 1968. It was approved by the FDA in the United States in 1991. Society and culture
Generic names
Estropipate is the generic name of the drug and its INN, USAN, and BAN. Brand names
Estropipate is or has been marketed under the brand names Genoral, Harmogen, Improvera, Ogen, Ortho-Est, and Sulestrex among others. Availability
Estropipate appears to remain available only in the United States. In the past, estropipate has also been marketed in Canada, the United Kingdom, Ireland, Switzerland, Australia, South Africa, Mexico, and Indonesia. == References ==