Tetrodotoxin

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

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)

Disposition

• Admit, may need ICU

See Also

• Marine toxins and envenomations