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.
There is no specific antidote for paralytic shellfish or puffer fish poisoning.
There are anecdotal reports of successful treatment of acute neurologic symptoms with mannitol, 1 g/kg intravenously, but this approach is not widely accepted.
Antihistamines such as diphenhydramine, 25–50 mg intravenously, and the H2-blocker cimetidine, 300 mg intravenously, are usually effective.
et al. Ciguatera poisoning in French Polynesia: insights into the novel trends of an ancient disease. New Microbes New Infect. 2019 Jun 7;31:100565.
et al. Histamine food poisonings: a systematic review and meta-analysis. Crit Rev Food Sci Nutr. 2018 May 3;58(7):1131–51.
et al. Is mannitol
the treatment of choice for patients with ciguatera fish poisoning? Clin Toxicol (Phila). 2017 Nov;55(9):947–55.
DA. Venomous bites, stings, and poisoning: an update. Infect Dis Clin North Am. 2019 Mar;33(1):17–38.