tetrodotoxin and Respiratory-Insufficiency

Topics: Action Potentials; Anesthesia, Local; Animals; Chemical Phenomena; Chemistry; Fishes, Poisonous; Foodborne Diseases; Humans; Hypotension; Hypothermia; Muscle, Smooth; Neuromuscular Junction; Respiration, Artificial; Respiratory Insufficiency; Tetrodotoxin; Vomiting

Poisoning after eating puffer fish containing highly lethal tetrodotoxin (TTX) is widespread in Asia. In 2008, naïve inland populations in Bangladesh were exposed to cheap puffer fish sold on markets. In three outbreaks, 141 patients with history of puffer fish consumption were hospitalized. Symptoms of poisoning included perioral paraesthesia, tingling over the entire body, nausea and vomiting, dizziness, headache, abdominal pain and muscular paralysis of the limbs. Seventeen patients (12%) died from rapidly developing respiratory arrest. Blood and urine samples from 38 patients were analyzed using a TTX-specific enzyme-linked immunoassay (ELISA). Medium to high TTX levels were detected (1.7-13.7 ng/ml) in the blood of 27 patients. TTX was below detection level (< 1.6 ng/ml) in 11 blood samples but the toxin was detected in urine. Ten patients had blood levels above 9 ng/ml and developed paralysis; seven of these died. The remaining patients recovered with supportive treatment. High concentrations of TTX and its analogues 4-epiTTX and 4,9-anhydroTTX were also found in cooked puffer fish by post-column liquid chromatography-fluorescence detection. To prevent future instances of puffer fish poisoning of this magnitude, measures should be implemented to increase awareness, to control markets and to establish toxicological testing. To improve the management of this and other poisoning in Bangladesh, facilities for life-saving assisted ventilation and related training of healthcare personnel are urgently needed at all levels of the health system.

Topics: Adolescent; Adult; Animals; Bangladesh; Child; Child, Preschool; Chromatography, Liquid; Disease Outbreaks; Enzyme-Linked Immunosorbent Assay; Female; Fishes, Poisonous; Foodborne Diseases; Humans; Male; Middle Aged; Paralysis; Poverty Areas; Respiratory Insufficiency; Tetraodontiformes; Tetrodotoxin; Young Adult

To define the clinical nature of tetrodotoxin intoxication and explore the measures for its emergency rescue.. The emergency rescue measures and outcomes of 33 cases tetrodotoxin intoxication were reviewed.. No obvious effects were observed in these patients after administration of atropine or application of respiratory stimulant, but implementation of mechanical ventilation and comprehensive life support measures resulted in successful rescue of mild to moderate cases within 10 to 14 h, and recovery of spontaneous respiration was achieved in critical cases in 19-24 h.. Tetrodotoxin selectively blocks the neuromuscular electrical activity, producing the effect of nondepolarizing curine and leading to failure of the respiratory drive without compromising the respiratory center. Atropine, a M-cholinergic receptor blocker, or central stimulants may fail to produce obvious effects, but comprehensive treatments including maintenance of effective ventilation can bring satisfactory effects.

Topics: Adolescent; Adult; Aged; Animals; Atropine; Emergencies; Female; Humans; Male; Middle Aged; Respiration, Artificial; Respiratory Insufficiency; Tetraodontiformes; Tetrodotoxin

We report three cases of a collective tetrodotoxin poisoning, after ingestion of puffer fish eggs. This neurotoxin is the most potent membrane stabilizer, blocking the nervous conduction and resulting in death from respiratory paralysis in case of massive ingestion. The father died at admission, the mother and her daughter presented an acute respiratory failure and a flaccid tetraplegia, with favourable outcome after 24 hours.

Topics: Acute Disease; Adolescent; Adult; Animals; Cranial Nerve Diseases; Eggs; Fatal Outcome; Female; Fishes, Poisonous; Gastrointestinal Contents; Humans; Ion Channels; Ion Transport; Male; Mice; Middle Aged; Neural Conduction; Paresthesia; Quadriplegia; Respiration, Artificial; Respiratory Insufficiency; Respiratory Paralysis; Tetrodotoxin

Topics: Adult; Animals; Fishes, Poisonous; Foodborne Diseases; Headache; Humans; Male; Paralysis; Respiratory Insufficiency; Sensation Disorders; Tetrodotoxin

Topics: Adolescent; Adult; Animals; Child; Child, Preschool; Female; Fishes, Poisonous; Humans; Malaysia; Male; Respiratory Insufficiency; Tetrodotoxin

Topics: Animals; Arrhythmias, Cardiac; Blood Pressure; Contracture; Electrocardiography; Heart; Male; Paralysis; Rats; Respiratory Insufficiency; Respiratory Paralysis; Scorpions; Tetrodotoxin; Venoms

Topics: Animals; Blood Pressure; Cats; Dogs; Hypotension; Muscles; Paralysis; Peripheral Nerves; Respiration; Respiratory Insufficiency; Tetrodotoxin; Toxins, Biological