Tetrodotoxin poisoning : a clinical analysis, role of neostigmine and short-term outcome of 53 cases

• Published in: Singapore medical journal Vol. 48; no. 9; pp. 830 - 833
• Main Authors: CHOWDHURY, F. R, NAZMUL AHASAN, H. A. M, MAMUNUR RASHID, A. K. M, AL MAMUN, A, KHALIDUZZAMAN, S. M
• Format: Journal Article
• Language: English
• Published: Singapore Singapore Medical Association 01.09.2007
• Subjects: Adolescent; Adult; Animals; Biological and medical sciences; Child; Female; Foodborne Diseases - complications; Foodborne Diseases - diagnosis; Foodborne Diseases - drug therapy; General aspects; Humans; Male; Medical sciences; Neostigmine - therapeutic use; Nervous system (semeiology, syndromes); Nervous system as a whole; Neurology; Parasympathomimetics - therapeutic use; Poisons - adverse effects; Tetraodontiformes; Tetrodotoxin - poisoning; Treatment Outcome; Antiglaucomatous agent; Short term; Sensitivity disorder; Prognosis; Neostigmine bromide; Esterases; Paresthesia; Evolution; Tropical medicine; Fish; neostigmine; Anticholinesterase agent; Neurological disorder; Human; Nervous system diseases; perioral paraesthesia; Enzyme; Enzyme inhibitor; puffer fish; Cholinesterase; Carboxylic ester hydrolases; Diagnostic agent; Chemotherapy; Treatment; Hydrolases; Poisoning; tetrodotoxin
• ISSN: 0037-5675

Puffer fish (tetrodotoxin) poisoning is now a common form of poisoning throughout coastal countries, but its diagnosis and management are still unclear. In this paper, we aim to share our experience and to find out the toxic manifestations, lag period between ingestion of fish and development of symptoms, the short-term clinical outcome, and value of neostigmine in its management. The study was carried out in the Department of Medicine and Paediatrics, Khulna Medical College Hospital, Khulna, Bangladesh, from May 1, 2001 to May 1, 2006. A total of 53 patients were admitted with the history of puffer fish ingestion. All the cases were clinically analysed from admission to discharge, for the following variables: Onset of symptoms in minutes after the ingestion of fish, toxic manifestations that developed after ingestion, relation of clinical outcome with approximate amount of fish ingested, and the role of neostigmine. All patients developed toxic manifestation. Important symptoms were perioral paraesthesia (38), weakness of all limbs (33), paraesthesia all over the body (34), headache (25), and difficulty in respiration. Eight patients died, probably due to respiratory muscle paralysis, of which five patients died immediately after admission. We used neostigmine in those patients who developed respiratory failure. 13 patients improved significantly (p-value is less than 0.5), while only three patients died. Because of the availability and affordability of puffer fish, the occurrence of tetrodotoxin poisoning throughout coastal countries is very likely. Therefore, health personnel should have enough knowledge regarding its toxic manifestations and management.