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Tetrodotoxin
From WikEM
Contents
Background
- Neurotoxin found in several marine animals (pufferfish, certain angelfish, blue-ringed octopus)
- Blocks neuronal action potential by blocking voltage-gated sodium channels
- Consumption of improperly prepared pufferfish responsible for vast majority of human toxicity
Clinical Features
Onset of symptoms usually within 30 min to 4 hours after eating pufferfish
- Paresthesias
- Headache
- Vomiting, diarrhea, abdominal pain
- Ascending paralysis
- Respiratory failure
- Death
Differential Diagnosis
Marine toxins and envenomations
- Toxins
- Scombroid
- Ciguatera
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Tetrodotoxin (e.g. pufferfish)
- Stingers
- Venomous fish (catfish, zebrafish, scorpion fish, stonefish)
- Lionfish
- Sea urchins
- Cone shells
- Nematocysts
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Coral reef
- Fire Corals
- Sea anemones
- Sea wasps
- Bites
Evaluation
- Pufferfish can be tested for the toxin, but decision to treat should be based on clinical picture
- Evaluate for other treatable causes of symptoms
Management
- Supportive care, intubate if concern for progressive paralysis
- Acetylcholinesterase inhibitors (e.g. neostigmine)[1]
Disposition
- Admit, may need ICU
See Also
External Links
References
- ↑ Tintanelli's
