Despite the fact that sahuagin usually fought each other to the death since they were in the nursery, blood challenges carried a more formalized tone. When there were two sahuagin that differed in their positions and were not willing to work it out through dialogue, one might issue a blood challenge to the other. Insults and insubordination could also constitute enough to issue a challenge; no refusal was accepted, for the culture and doctrine of the sahuagin greatly despised weakness and only the mighty could keep living, which would be proved through victory only. Even though sahuagin were savage, they would not issue a blood challenge against an injured opponent, nor would they issue a second blood challenge if the first one was won but left the winner injured. That ensured that no successive blood challenges would be issued in order to ensure someone's death.
When the challenge was issued, there would be no interference from third parties and the two participants had to fight until one died. The losing sahuagin was often eaten by the victor and the other sahuagin present.
In her search for the One that Swims with Sekolah, Laaqueel, a malenti priestess, was accompanied by three other sahuagin. Since they had been searching for months without results, in the Year of the Bow, 1354 DR, Thuur scorned her and argued that they should go back. Since Laaqueel did not change her mind and found her behavior intolerable, they fought to the death in a blood challenge where the other two sahuagin were only witnesses. After Laaqueel prevailed, they ate Thuur's body and left the remains for the sharks and other scavengers.
In the Year of the Gauntlet, 1369 DR, when Huaanton told Iakhovas to produce a sign of Sekolah's approval for his ambitious plans to wage war against all land-dwellers, Iakhovas summoned the kraken that had been guarding the royal palace as a sign of divine support. However, the sahuagin king accused him of magic, which prompted the issuing of a blood challenge that resulted in Iakhovas's victory and ascension to the position of king among the sahuagin.