tetrodotoxin and Poisoning

Although exposure to animal venom and poison, such as snakebites, bee stings, and contact, with toads, is a common problem, reported deaths are rare. The present report discusses 18 fatal cases in China. Causes of death were grouped into 6 categories, including 1 case of tetrodotoxin poisoning, 1 case of gallbladder poisoning, 3 cases of snake venom toxicity, 4 cases of melittin toxicity, 4 cases of cantharidin poisoning and 5 cases of venenum bufonis poisoning. The epidemiology of each venom-induced death, the mechanism of exposure to venom, and the target organs and tissues affected by these toxic animals were here systematically reviewed. Such details are important to even suspected cases of venom damage. The associated problems related to forensic medicine, such as manner of death and possible attribution to the toxic effects of various animals, are also discussed herein.

Topics: Abortifacient Agents; Adolescent; Adult; Amphibian Venoms; Animals; Bees; Bites and Stings; Cantharidin; Child; Child, Preschool; China; Female; Fishes; Forensic Toxicology; Gallbladder; Humans; Male; Melitten; Middle Aged; Poisoning; Snake Bites; Snake Venoms; Tetraodontiformes; Tetrodotoxin; Young Adult

Topics: Adult; Blood-Brain Barrier; Diabetes Insipidus; Humans; Male; Poisoning; Tetrodotoxin

Many pufferfish possess tetrodotoxin (TTX). Unaware of this fact, the owner of a 3-mo-old pet Cuvier's dwarf caiman ( Paleosuchus palpebrosus ) fed the caiman a green spotted pufferfish ( Tetraodon nigroviridis ), acquired from a local discount department store. The caiman was nonresponsive within an hour of consumption of the fish. The caiman was presented for veterinary evaluation but died despite intensive medical care. High-performance liquid chromatography and a competitive inhibition enzyme immunoassay were used to determine whether the pufferfish was tetrodotoxic and whether the deceased caiman had TTX in its system. Skin and liver of the pufferfish harbored high concentrations of TTX, and the caiman had TTX in the blood, liver, and kidney. The clinical signs and presence of TTX in the caiman suggest that the caiman succumbed to tetrodotoxicosis. The implication is that lethally poisonous species are available commercially and pose a danger to other pets and possibly small children.

Topics: Alligators and Crocodiles; Animals; Poisoning; Predatory Behavior; Tetraodontiformes; Tetrodotoxin

Tetrodotoxin (TTX) poisoning, although uncommon, is frequently seen in Taiwan, Japan, and Southeast Asia. It is rare but significant in the United States as well. Only three cases have been reported in the EM literature. We report an outbreak of six cases of TTX poisoning from eating puffer fish. On April 17, 2001, an outbreak of TTX poisoning occurred among Mainland Chinese fishermen who shared puffer fish on their boat in the Taiwan Strait. All six cases were middle-aged men (aged 32-49 yr). Onset of symptoms began approximately 2 to 3 hours after ingestion; symptoms included orolingual numbness, acroparesthesia, and breathlessness. As a result of delayed transportation and initial resuscitation, one patient presented in full cardiac arrest, with recovery of spontaneous circulation after successful cardiopulmonary resuscitation. With the exception of this patient, the initial acid-base abnormalities were inconsistent with severity of illness and mild hypercapnia was common (4 out of 5). The patient who presented in full arrest died 1 day after admission as a result of intractable bradycardia (complete atrioventricular block), a finding rarely mentioned in the literature, despite intravenous atropine and dopamine infusion. The remaining patients survived without significant sequelae and were discharged after short-term observation and supportive care, although some had neurologic and cardiopulmonary manifestations (muscle weakness, hypotension, hypoxemia, and hypercapnia). Some mildly hypoventilated patients recovered well without endotracheal intubation and ventilatory support. Favorable outcomes in most patients can be obtained if aggressive supportive treatment is provided in time. Thus, appropriate prehospital and ED ventilatory support (the implementation of a bag-valve mask or endotracheal intubation with good ventilatory support) is mandatory for those patients with respiratory failure. Most patients experience onset of symptoms within 6 hours of ingestion, but a few have a delayed onset up to 20 hours. Therefore, for those TTX-intoxicated patients without immediate prominent respiratory insufficiency, at least 24 hours of intensive monitoring of their respiratory state is necessary because of the different susceptibility and unpredictability of an individual course.

Topics: Adult; Anesthetics, Local; Dose-Response Relationship, Drug; Humans; Male; Middle Aged; Poisoning; Tetrodotoxin

Topics: Animals; Animals, Domestic; Female; Poisoning; Salamandridae; Tetrodotoxin

Tetrodotoxin (TTX) poisonings are not infrequently seen in Taiwan, and several outbreaks have been recorded by the Poison Control Center (PCC)-Taiwan during 1988-1995. However, their demographic data, clinical features, and medical outcome have not been reported. A retrospective study analyzed the PCC data of TTX poisonings. All patients reported to the PCC-Taiwan as TTX poisoning from July 1988 through December 1995 were included. Excluding 2 incidents, the diagnosis of TTX poisoning was documented by identification of puffer fish and/or by the analysis of TTX in it. Patient age, sex, season of poisoning, substances ingested, incubation period, presenting symptoms, recovery time, and clinical outcome were analyzed. A total of 20 incidents involved 52 patients. Males outnumbered females (52% vs 41%) with sex undetermined in 4 patients. Most incidents occurred in the spawning seasons of puffer fish, eg March to May. Puffer fish ingestion accounted for 18 incidents; ingestion of gastropod mollusks and Gobius criniger were responsible for the other 2 incidents. Following ingestion of puffer fish and other poisonous marine animals, most symptoms developed within 6 h with complete recovery usually in 24 h. Symptoms of TTX poisoning were similar as those previously reported; however, unusual features, such as hypertension (24%), pinpoint pupils (4%), bronchorrhea and facial flush (2%), were also seen. The mortality rate was 13.5%. The violent neurotoxin is present in puffer fish and occurs in other marine animals. Without adequate therapy, patients may have serious morbidity or even succumb. Careful identification of puffer fish and other poisonous marine animals, as well as proper treatment of TTX poisoning patients, are mandatory to successfully handle cases of TTX poisoning.

Topics: Aging; Cohort Studies; Female; Humans; Longitudinal Studies; Male; Marine Toxins; Poison Control Centers; Poisoning; Retrospective Studies; Sex Factors; Statistics as Topic; Taiwan; Tetrodotoxin

Topics: Animals; Cnidaria; Echinodermata; Fishes, Poisonous; Holothurin; Marine Toxins; Poisoning; Saxitoxin; Tetrodotoxin; Venoms

An account is given of some aspects of poisonings sustained by coming into contact with animals of the coral reefs of the Fiji Islands. Poisonings can be grouped into those in which the toxin is introduced parenterally-envenomings, and those in which it is ingested. Illustrative case histories are presented of injuries from 2 echinoderms and of envenoming from the "deadly" stonefish. A therapeutic approach to puffer-fish poisoning is mentioned and the problem of ciguatera poisoning is outlined.

Topics: Adult; Animals; Echinodermata; Female; Fiji; Fishes, Poisonous; Humans; Infusions, Parenteral; Male; Marine Toxins; Oceanography; Poisoning; Tetrodotoxin; Tropical Climate

Topics: Animals; Fishes, Poisonous; History, 19th Century; History, 20th Century; Humans; Japan; Poisoning; Tetrodotoxin

Topics: Alkalies; Lye; Poisoning; Tetrodotoxin