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A variety of intoxications may occur after eating certain types of fish or other seafood. These include scombroid, ciguatera, paralytic shellfish, and puffer fish poisoning. The mechanisms of toxicity and clinical presentations are described in Table 38–8. In the majority of cases, the seafood has a normal appearance and taste (scombroid may have a peppery taste).

Table 38–8.Common seafood poisonings.


A. Emergency and Supportive Measures

Caution: Abrupt respiratory arrest may occur in patients with acute paralytic shellfish and puffer fish poisoning. Observe patients for at least 4–6 hours. Replace fluid and electrolyte losses from gastroenteritis with intravenous saline or other crystalloid solution.

For recent ingestions, it may be possible to adsorb residual toxin in the gut with activated charcoal, 50–60 g orally.

B. Specific Treatment

There is no specific antidote for paralytic shellfish or puffer fish poisoning.

1. Ciguatera

There are anecdotal reports of successful treatment of acute neurologic symptoms with mannitol, 1 g/kg intravenously, but this approach is not widely accepted.

2. Scombroid

Antihistamines such as diphenhydramine, 25–50 mg intravenously, and the H2-blocker cimetidine, 300 mg intravenously, are usually effective.

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