The intoxication of tetraodontoxin from some species of fishes of the tetraodontidae accounted for 40-60% in the world, and 44,4% in Vietnam. The intoxication occurred most frequently in the major provinces such as Phu Yen, Qui Nhon, Quang Ngai, Ha Tinh, some times in Hai Phong and Ha Noi.
Poisoning ; Tetraodontiformes

For 5 years, the Intensive care unit of Hue central hospital treated 24 patients suffering from Puffer fish poisoning. Puffer fish are found in seas and rivers. 24 These 24 cases occurred in the sea areas of Thua Thien Hue province. Puffer fish contains Tetrodotoxin which is a potent neurotoxin. The specific clinical symptoms at admission: paresthetic tongue and lips (24 patients), paresthetic limbs, abdomen and chest (21 patients), abdominal pain and vomiting (20 patients), sweating (8 patients), headache (7 patients), bradycardia (7 patients), respiratory muscle paralysis must be artificial ventilation (1 patient). Treatment with gastric lavage, then ingestion of activated charcoal plus sorbitol is effective method. There was no deaths.
Poisoning ; Tetraodontiformes ; Therapeutics

We report serial change of nerve conduction tests, somatosensory evoked potentials and brainstem auditory evoked pontenials in a case of puffer fish poisoning, who recovered completely from comatous state with respiratory and generalized muscle paralysis.
Brain Stem ; Evoked Potentials, Somatosensory ; Neural Conduction ; Paralysis ; Poisoning* ; Tetraodontiformes*

Tetrodotoxin is a neurotoxin, so gastrointestinal symptoms are very rare ; these described in the literature are merely nausea and vomiting. Severe complications in the gastrointestinal tract caused by tetrodotoxin have not been radiologically reported. US and CT show thickening of the gastric wall and contraction of the lumen, andupper gastrointestinal series show shortening, lobulation and irregularity of the lesser and greater curevature ofthe body and antrum similar to the findings of corrosive gastritis.
Barium ; Eggs* ; Gastritis* ; Gastrointestinal Tract ; Nausea ; Ovum* ; Tetraodontiformes* ; Tetrodotoxin ; Vomiting

Ingestion of the eyes and many of the internal organs of puffer fish can result in severe and potentially lethal intoxication, but there is little available information regarding the results of grade IV tetrodotoxin (TTX) intoxication. Thus, we retrospectively reviewed and analyzed the clinical characteristics of ventilator therapy patients and those suffering respiratory failure after ingestion of TTX from puffer fish, who were admitted to our hospital from January 2002 to May 2011. Of the total patients evaluated, we observed seven cases of Fukuda classification grade IV TTX poisoning. All patients were discharged without any complications within 5-26 days after admission.
Eating ; Eye ; Humans ; Respiratory Insufficiency ; Retrospective Studies ; Stress, Psychological ; Tetraodontiformes ; Tetrodotoxin ; Ventilators, Mechanical

PURPOSE: We conducted this study in order to determine clinical features and prognostic factors in adults with acute tetrodotoxin (TTX) poisoning caused by ingestion of puffer fish. METHODS: In this retrospective study, 107 patients were diagnosed with TTX poisoning. The subjects were divided into two groups according to duration of treatment; Group I, patients were discharged within 48 hours (n=76, 71.0%), Group II patients were discharged after more than 48 hours (n=31, 29.0%). Group II was subsequently divided into two subgroups [IIa (n=12, 11.2%), IIb (n=19, 17.8%)] according to the need for mechanical ventilation support. RESULTS: In multivariable logistic regression analysis, the predictors of the need for treatment over 48 hours were dizziness (odds ratio [OR], 4.72; 95% confidence intervals [CI], 1.59-12.83), time interval between onset of symptom and ingestion (OR, 0.56; 95% CI, 0.16-0.97), PaCO2<35 mmHg (OR, 8.37; 95% CI, 2.37-23.59). In addition, predictors of the need for mechanical ventilation were a time interval between onset of symptoms and ingestion (OR, 0.54; 95% CI, 0.11-0.96) and PaCO2<35 mmHg (OR, 5.65; 95% CI, 1.96-18.66). CONCLUSION: Overall, dizziness, time interval between onset of symptoms and ingestion, DeltaDBP and PaCO2<35 mmHg predict the need for treatment over 48 hours, time interval between onset of symptoms and ingestion and PaCO2<35 mmHg predict the need for mechanical ventilation support after acute TTX poisoning.
Adult* ; Dizziness ; Eating ; Humans ; Logistic Models ; Poisoning* ; Respiration, Artificial ; Retrospective Studies ; Tetraodontiformes* ; Tetrodotoxin

A 54 year old man who had taken puffer fish and noticed generalized weakness 1 hour and 30 minutes afterward was admitted to our I.C.U. due to respiratory arrest and cardiac arrhythmia. He was treated with artificial respiration via pressure cycled respirator, supportive therapy including frequent endotracheal suctioning. fluid administration, correction of acid base imbalance, change of position and antibiotics for prevention of secondary infection. 31 hours afterward, he resumed normal respiration and clear mentality. After 5 days of total admission days, he was discharged without any sequelae.
Acid-Base Imbalance ; Anti-Bacterial Agents ; Arrhythmias, Cardiac ; Coinfection ; Poisoning* ; Respiration ; Respiration, Artificial ; Respiratory Paralysis* ; Suction ; Tetraodontiformes ; Tetrodotoxin* ; Ventilators, Mechanical

Tetrodotoxin (TTX) cause neurologic dysfunction by blocking the voltage-gated sodium channels located in all of the peripheral nerves and muscles. We experienced two patients presenting with generalized motor weakness after ingestion of pufferfish. The nerve conduction study showed diffuse slowing of motor and sensory nerve conduction velocity, prolonged motor terminal latency and decreased sensory nerve action potentials without temporal dispersion or conduction block. Abnormal findings of nerve conduction study improved rapidly without any deterioration. Clinical symptoms and signs ameliorated in accordance with findings of nerve conduction study without any neurologic sequelae. These imply that tetrodotoxication is reversible and functional neurologic disorder. We suggest that nerve conduction studies can be available in serial monitoring of tetrodotoxication as an objective means.
Action Potentials ; Eating ; Humans ; Muscles ; Nervous System Diseases ; Neural Conduction ; Neurologic Manifestations ; Peripheral Nerves* ; Tetraodontiformes ; Tetrodotoxin ; Voltage-Gated Sodium Channels

BACKGROUND: Puffer fish can be the source of lethal flood poisoning in humans. Tetrodotoxin(TTX) poisonings are not infrequency seen in Korea, but there are few clinical reports. So we reviewed the patients of TTX poisoning and analyzed the clinical characteristics of patients. METHODS: A retrospective study was performed of 40 patients who visited Chung Ang Gil Hospital from Jan. 1, 1995 to May. 31, 1998 with a diagnosis of TTX poisoning by a review of patients' medical records and telephone inquiries, The diagnosis of TTX poisoning was made by causal links between consumption of puffer fish and the development of typical symptoms of tetrodotoxication. The clinical severity of the patients in this study was classified according to the classification of Fukuda. RESULTS: Mean age of the patients was 40 years. The highest incidence was in the 4th decade in 21 patients(52.5%). The ratio of male to female was 3.44:1, Seasonal distribution excluding cases in 1998 was 12 patients in spring, 6 in summer, 5 in autumn and 12 in winter. The mean interval between consumption and symptom onset was 137 minutes. Common initial symptoms were circumoral numbness(32 patients) and paresthesia of extremities(24 patients). Various symptoms were developed after ingestion of puffer flesh such as neuromuscular(39 patients), cardiovascular/pulmonary (23 patients) and gastrointestinal (16 patients) system. Mean recovery time from the onset of symptom was 22.00 hours. All were treated with symptomatic and supportive measures and recovered completely without sequelae. In 2 cases ventilatory supports were applied for 18.5 hours and 31.5 hours respectively.
Classification ; Diagnosis ; Eating ; Female ; Humans ; Incidence ; Korea ; Male ; Medical Records ; Paresthesia ; Poisoning* ; Retrospective Studies ; Seasons ; Telephone ; Tetraodontiformes*

Ingestion of puffer fish can cause intoxication, which produces a wide range of symptoms due to the presence of neurotoxins, such as tetrodotoxin, in puffer fish. Abdominal pain is just one of the symptoms that should be treated with symptomatic and supportive therapy. This study reports a case of a 56-year-old male patient with abdominal pain, who was admitted to the emergency room with a diagnosis of puffer fish poisoning. In this case, the abdominal pain did not improve, but rather, the symptoms worsened. Finally, the cause of the abdominal pain was found to be hemoperitoneum due to active bleeding at the greater omentum, as observed on abdominal computed tomography; the source of bleeding was the right colic artery branch. Embolization was performed successfully, and the post-intervention course was uneventful. The patient was discharged without any complications within 13 days after admission.
Abdominal Pain ; Aneurysm ; Arteries ; Colic ; Eating ; Emergencies ; Hemoperitoneum ; Hemorrhage ; Humans ; Male ; Neurotoxins ; Omentum ; Rupture, Spontaneous ; Tetraodontiformes ; Tetrodotoxin