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

Ingestion of puffer fish can result in severe and potentially lethal intoxication, referred to as tetrodotoxin intoxication. Tetrodotoxin is a potent neurotoxin well known for its ability to ability neuromuscular function. Tetrodotoxin is a specific and potent blocker of axonal sodium channel; it may block sodium channels in the axon of the neurons of the neurohypophysis, thereby inhibiting the release of vasopressin and causing diabetes insipidus neurotoxin. To our knowledge, previous report on diabetes insipidus causing tetrodotoxin is the only one case in Singapore. A married couple (69-year-old man and 57-year-old woman) ingested two green rough-backed puffer fish (Lagocephalus lunaris). They complained of paresthesia on perioral area and extremity and developed not only grade IV intoxication but also an increased urine output (4455 ml/day and 5035 ml/day), elevated serum sodium (157.4 mEq/L and 166.7 mEq/L) and elevated serum osmolality (324 mosmol/kg and 339 mosmol/kg), which suggested the development of diabetes insipidus. The administration of desmopressin nasal spray was successful in normalizing urine volume. Both were discharged on 20th and 18th hospital day, respectively, without any complications.
Axons ; Deamino Arginine Vasopressin ; Diabetes Insipidus ; Eating ; Extremities ; Neurons ; Osmolar Concentration ; Paresthesia ; Pituitary Gland, Posterior ; Sodium ; Sodium Channels ; Tetraodontiformes ; Tetrodotoxin ; Vasopressins

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

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: Ingestion of puffer fish can be poisonous due to the presence of potent neurotoxins such as tetrodotoxin (TTX) found in its tissues. There are few clinical reports related to TTX. We performed this study to evaluate the clinical characteristics of TTX poisoning. METHODS: We conducted a retrospective study of the 41 patients diagnosed with TTX poisoning who visited the Seoul Asan medical center from July 2004 and December 2010. A review of patients'electronic medical records and patient telephone interviews were conducted. Diagnosis of TTX poisoning was confirmed by observing the casual link between puffer fish consumption and the development of typical TTX intoxication symptoms. RESULTS: The mean age of the patients included in the study was 46.6 years. The highest incidence of intoxication was observed in patients in their 50s (10 patients). Seasonal distribution of intoxication events included 10 in spring, 7 in summer, 10 in fall, and 14 in winter. In most cases, symptoms occurred within 1 hour of ingestion. A wide range of symptoms were associated with puffer fish ingestion affecting multiple body systems including neuromuscular (27 patients), gastrointestinal (19 patients), and cardiopulmonary/vascular (19 patients). All patients were treated with symptomatic and supportive therapy and recovered completely, without sequelae, within 48 hours. In three cases, ventilator support was required. CONCLUSION: TTX poisoning is not seasonally related, and patients admitted to the emergency room were observed with a wide range of symptoms. Where TTX poisoning is diagnosed, supportive therapy should be performed. Early intubation and ventilation is important, especially is cases of respiratory failure.
Aluminum Hydroxide ; Carbonates ; Eating ; Emergencies ; Humans ; Incidence ; Interviews as Topic ; Intubation ; Medical Records ; Neurotoxins ; Respiratory Insufficiency ; Retrospective Studies ; Seasons ; Tetraodontiformes ; Tetrodotoxin ; Ventilation ; Ventilators, Mechanical

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

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*

Tetrodotoxin is a neurotoxin produced by about 90 species of puffer fish and causes paralysis of central nervous system and peripheral nerves by blocking the movement of all monovalent cations. Ingestion of tetrodotoxin produces clinical manifestations such as paresthesias(within 10-45 min), vomiting, lightheadedness, salivation, muscle twitching, dysphagia, difficulty in speaking, convulsion and death that expressed by cardiopulmonary arrest with loss of brain stem reflex sometimes. Tetrodotoxin prevents or delays ischemia induced neuronal death by way of following 3 mechanisms. Firstly, it reduces the energy demand of the brain tissues. Secondly, it delays or even prevents anoxic depolarization. Finally, it diminishes ischemia induced cell swelling and cerebral edema. We report a case of puffer fish poisoning which presented with cardiopulmonary arrest and loss of brain stem reflex, but completely recovered by aggressive cardiopulmonary resuscitation.
Brain ; Brain Edema ; Brain Stem ; Cardiopulmonary Resuscitation ; Cations, Monovalent ; Central Nervous System ; Deglutition Disorders ; Dizziness ; Eating ; Heart Arrest ; Ischemia ; Neurons ; Paralysis ; Peripheral Nerves ; Poisoning* ; Reflex ; Salivation ; Seizures ; Tetraodontiformes* ; Tetrodotoxin ; Vomiting

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