Tetrodotoxin: Difference between revisions
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==Management== | ==Management== | ||
*Supportive care | *Supportive care is mainstay of treatment | ||
*[[Acetylcholinesterase inhibitors]] (e.g. [[neostigmine]]) | *May require intubation if concern for progressive paralysis | ||
*[[Acetylcholinesterase inhibitors]] (e.g. [[neostigmine]]) | |||
==Disposition== | ==Disposition== | ||
*Admit | *Admit (may need ICU) | ||
==External Links== | |||
==See Also== | ==See Also== | ||
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==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Toxicology]] | [[Category:Toxicology]] | ||
Latest revision as of 22:45, 27 March 2024
Background
- Neurotoxin found in several marine animals (pufferfish, certain angelfish, blue-ringed octopus)
- Heat-stable toxin not destroyed by washing, freezing or cooking
- Blocks neuronal action potential by blocking voltage-gated sodium channels
- Consumption of improperly prepared pufferfish responsible for vast majority of human toxicity (e.g. fugu restaurants)
Mechanism of Injury
- Tetrodotoxin binds to and blocks fast-gated sodium channels, blocking conduction of nerve signals.
Clinical Features
Onset of symptoms usually within 30 min to 4 hours after eating pufferfish
- Paresthesias, body numbness
- Dysarthria, dysphagia
- Headache
- Vomiting, diarrhea, abdominal pain
- Ascending paralysis
- Respiratory failure
- Death
Differential Diagnosis
Marine toxins, envenomations, and bites
- Toxins
- Ciguatera
- Scombroid
- Tetrodotoxin (e.g. pufferfish)
- Shellfish poisoning
- Amnesic shellfish poisoning
- Diarrheal shellfish poisoning
- Neurotoxic shellfish poisoning
- Paralytic shellfish poisoning
- Stingers
- Venomous fish
- Cone shell
- Lionfish
- Sea urchins
- Crown-of-Thorns Starfish
- Stonefish
- Other: Catfish, zebrafish, scorpion fish
- Nematocysts
- Coral reef
- Fire coral
- Jellyfish (Cnidaria)
- Portuguese man-of-war
- Sea anemones
- Seabather's eruption
- Phylum porifera (sponges)
- Bites
- Infections
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 is mainstay of treatment
- May require intubation if concern for progressive paralysis
- Acetylcholinesterase inhibitors (e.g. neostigmine)
Disposition
- Admit (may need ICU)