Heat resistant toxin found in fish, thus cooking doesn't protect you
Found in over 400 species of fish but bioaccumulates in fish so predator tropical reef fish have higher concentration: grouper, barrucuda, snapper, parrotfish
Found in tropical areas (See attached map for hot bed locations - in case you vacation there)
Clinical Findings: Very neat hot-cold reversal where you place you hand in bucket of ice water and it feels like it is burning and visa versa, GI symptoms, paresthesias, ataxia and even hallucinations (very cool)
Treatment: attempts with mannitol and gabapentin are reasonable and safe but completely unproven. Supportive care
