Chowdhury FR, Nazmul Ahasan HAM, Mamunur Rashid AKM, Al Mamun A, Khaliduzzaman SM
Correspondence: Dr Fazle Rabbi Chowdhury, shakilrabbi@yahoo.com
ABSTRACT
Introduction Puffer fish (tetrodotoxin) poisoning is now a common form of poisoning throughout coastal countries, but its diagnosis and management are still unclear. In this paper, we aim to share our experience and to find out the toxic manifestations, lag period between ingestion of fish and development of symptoms, the short-term clinical outcome, and value of neostigmine in its management.
Methods The study was carried out in the Department of Medicine and Paediatrics, Khulna Medical College Hospital, Khulna, Bangladesh, from May 1, 2001 to May 1, 2006. A total of 53 patients were admitted with the history of puffer fish ingestion. All the cases were clinically analysed from admission to discharge, for the following variables: Onset of symptoms in minutes after the ingestion of fish, toxic manifestations that developed after ingestion, relation of clinical outcome with approximate amount of fish ingested, and the role of neostigmine.
Results All patients developed toxic manifestation. Important symptoms were perioral paraesthesia (38), weakness of all limbs (33), paraesthesia all over the body (34), headache (25), and difficulty in respiration. Eight patients died, probably due to respiratory muscle paralysis, of which five patients died immediately after admission. We used neostigmine in those patients who developed respiratory failure. 13 patients improved significantly (p-value is less than 0.5), while only three patients died.
Conclusion Because of the availability and affordability of puffer fish, the occurrence of tetrodotoxin poisoning throughout coastal countries is very likely. Therefore, health personnel should have enough knowledge regarding its toxic manifestations and management.
Keywords: neostigmine, perioral paraesthesia, poisoning, puffer fish, tetrodotoxin
Singapore Med J 2007; 48(9): 830–833
