Title: “Food poisoning”: How do you like your fish? <br/>Author: Hong Kim<br/><a href='http://umem.org/profiles/faculty/526/'>[Click to email author]</a><hr/><p>
Food poisoning can occur with many different food groups/items, as well as how the food is prepared, handled or stored.</p>
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There are three specific “food poisonings” associated with fish consumption can cause serious toxicity/illness beyond GI symptoms: Ciguatera, Scrombroid, tetrodotoxin (puffer fish)</p>
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<strong>Ciguatera</strong></p>
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Endemic to warm tropical water and bottom reef dwelling large carnivorous fish: grouper, red snapper, barracuda, amberjack, parrot fish, etc. (> 500 species).</li>
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Toxin: ciguatoxin: opens voltage gated Na channel</li>
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Produced by dinoflagellates (gambierdiscus toxicus) and bioaccumulates in large fish through food chain (eating small fish).</li>
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Symptoms:</p>
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GI symptoms: n/v/d and abdominal pain</li>
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Hot/cold reversal</li>
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Paresthesia of tongue/lip >> extremities</li>
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Dental pain: “loose teeth”</li>
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May progress to develop…</p>
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T wave changes, bradycardia, hypotension</li>
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Respiratory paralysis and pulmonary edema</li>
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Treatment: supportive care and mannitol in presence of severe neurologic symptoms (limited evidence).</p>
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<strong>Scrombroid</strong></p>
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Endemic in (dark meat) fish living in temperate or tropical water: amberjack, skipjack, tuna, mackerel, albacore, mahi mahi, etc.</li>
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Associated with poor refrigeration/storage after catching fish.</li>
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Histidine in tissue is converted to histamine by bacteria on the fish skin.</li>
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Symptoms:</p>
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GI symptoms: n/v/d and abdominal pain</li>
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Upper body flushing</li>
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Puritis, urticarial and perioral swelling can occur</li>
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Palpitation and mild hypotension</li>
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Tx: H1/H2 blockers and supportive care</p>
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Serious reactions: treat like allergic/anaphylactic reaction</p>
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<strong>Tetrodotoxin</strong></p>
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Ingestion of improperly prepared puffer fish (fugu) sushi (or bite from blue ring octopus)</li>
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Toxin: tetrodotoxin: blocks voltage gated Na channel.</li>
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Highest concentration in liver and ovary.</li>
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Symptoms:</p>
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GI: n/v/d</li>
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Progressive paresthesia and weakness (bulbar-> extremities), ataxia</li>
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Ascending paralysis and respiratory distress/paralysis</li>
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Dysrythmia and hypotension</li>
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Mental status preserved.</li>
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Treatment: supportive care and intubated if needed.</p>