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For further information, see CMDT Part 38-54: Seafood Poisonings

Key Features

  • In most cases, the seafood has a normal appearance and taste

  • Scombroid may have a peppery taste

Clinical Findings

  • A variety of intoxications may occur, including scombroid, ciguatera, paralytic shellfish, and puffer fish poisoning (Table 38–8)

  • Abrupt respiratory arrest may occur with acute paralytic shellfish and puffer fish poisoning

Table 38–8.Common seafood poisonings (listed in alphabetical order).



  • Observe patients for at least 4–6 h

  • Replace fluid and electrolyte losses from gastroenteritis with intravenous saline or other crystalloid solution

  • Administer activated charcoal (50–60 mg orally) for recent ingestions

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

  • Ciguatera

    • Acute neurologic symptoms may respond to mannitol, 1 g/kg intravenously (anecdotal)

  • Scombroid

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

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