Tetrodotoxin: Difference between revisions
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**Heat-stable toxin not destroyed by washing, freezing or cooking | **Heat-stable toxin not destroyed by washing, freezing or cooking | ||
*Blocks neuronal action potential by blocking voltage-gated sodium channels | *Blocks neuronal action potential by blocking voltage-gated sodium channels | ||
*Consumption of improperly prepared pufferfish responsible for vast majority of human toxicity | *Consumption of improperly prepared pufferfish responsible for vast majority of human toxicity (e.g. fugu restaurants) | ||
[[File:Blue-ringed-octopus.jpeg|thumbnail]] | [[File:Blue-ringed-octopus.jpeg|thumbnail]] | ||
==Mechanism of Injury== | |||
*Tetrodotoxin binds to and blocks fast-gated sodium channels, blocking conduction of nerve signals. | |||
==Clinical Features== | ==Clinical Features== | ||
''Onset of symptoms usually within 30 min to 4 hours after eating pufferfish'' | ''Onset of symptoms usually within 30 min to 4 hours after eating pufferfish'' | ||
| Line 28: | Line 32: | ||
==Disposition== | ==Disposition== | ||
*Admit, may need ICU | *Admit, may need ICU | ||
==See Also== | ==See Also== | ||
*[[Marine toxins and envenomations]] | *[[Marine toxins and envenomations]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
==Video== | |||
{{#widget:YouTube|id=0DyrwwGQnlI}} | |||
[[Category:Toxicology]] | [[Category:Toxicology]] | ||
Revision as of 16:14, 4 March 2019
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, intubate if concern for progressive paralysis
- Acetylcholinesterase inhibitors (e.g. neostigmine)[1]
Disposition
- Admit, may need ICU
See Also
References
- ↑ Tintanelli's
Video
{{#widget:YouTube|id=0DyrwwGQnlI}}